Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4301081769 | MI |
N | 207PE0004X | Emergency Medical Services | 057906 | GA |
NPI | 1053360040 |
---|---|
Provider Name | Charles Hooshmand Nightingale |
First Address | Saginaw, MI 48604-2846 |
Second Address | Saginaw, MI 48601-2551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |