Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301081081 | MI |
NPI | 1144280124 |
---|---|
Provider Name | Brett R Todd |
First Address | Royal Oak, MI 48073-6769 |
Second Address | Royal Oak, MI 48073-6769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4501086 | (05) | MI |
H62342 | (02) | MI |