Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4301076073 | MI |
Y | 207PE0004X | Emergency Medical Services | 4301076073 | MI |
NPI | 1043293897 |
---|---|
Provider Name | Brian T West |
First Address | Palatine, IL 60055-0001 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2005 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4488055 | (05) | MI |
4488082 | (05) | MI |
4488091 | (05) | MI |
BW076073 | BLUE CROSS BLUE SHIELD (01) | |
H86640 | (02) | MI |
P00058605 | RAILROAD MEDICARE (01) |