Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CS001382 | MI |
Y | 222Z00000X | Podiatrist | CS001382 | MI |
NPI | 1063499630 |
---|---|
Provider Name | Charles R Solon III |
First Address | Grand Rapids, MI 49546-4800 |
Second Address | Grand Rapids, MI 49546-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4376578 | (05) | MI |
T34015 | (02) | MI |