Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301060165 | MI |
N | 207YS0123X | Facial Plastic Surgeon | 4301060165 | MI |
NPI | 1871680645 |
---|---|
Provider Name | Charles M Boyd |
First Address | Birmingham, MI 48009-6301 |
Second Address | Birmingham, MI 48009-6301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 03/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F99455 | (02) | MI |