Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 4301117252 | MI |
NPI | 1174865174 |
---|---|
Provider Name | Benjamin Matthew Strong |
First Address | Grand Rapids, MI 49503-5731 |
Second Address | Grand Rapids, MI 49503-5731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2013 |
Last Update Date | 05/12/2019 |