Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 4301043303 | MI |
NPI | 1194783936 |
---|---|
Provider Name | Bernard Kent Maupin |
First Address | Grand Rapids, MI 49525-6406 |
Second Address | Grand Rapids, MI 49525-6406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 12/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3152810 | (05) | MI |
B43281 | (02) |