Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 4301036561 | MI |
NPI | 1013972934 |
---|---|
Provider Name | Bryan P Shumaker |
First Address | Boyne City, MI 49712-8816 |
Second Address | Boyne City, MI 49712-8816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 05/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A76750 | (02) | MI |
A76750 | HAP (01) | MI |