Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101019204 | MI |
NPI | 1265724603 |
---|---|
Provider Name | Benjamin J Visger |
First Address | Muskegon, MI 49443-1847 |
Second Address | Muskegon, MI 49444-1871 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 02/05/2014 |