Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 4301042599 | MI |
NPI | 1003881376 |
---|---|
Provider Name | Bryan J Dunlop |
First Address | Kalamazoo, MI 49008-2380 |
Second Address | Kalamazoo, MI 49008-2380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1715786 | (05) | MI |
E25553 | (02) | MI |