Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2301011000 | MI |
N | 111NN0400X | Neurology | CH11461 | FL |
N | 111NN0400X | Neurology | CHIR009527 | GA |
N | 111NN0400X | Neurology | CR2339 | ME |
NPI | 1699139279 |
---|---|
Provider Name | Brian Sass |
First Address | Grand Rapids, MI 49546-3728 |
Second Address | Grand Rapids, MI 49546-3728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2016 |
Last Update Date | 03/06/2021 |