Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 4301110881 | MI |
NPI | 1689962342 |
---|---|
Provider Name | Christopher Minnock |
First Address | Troy, MI 48084 |
Second Address | Troy, MI 48084-5246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 17/03/2018 |