Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | Q4042 | TX |
Y | 207Q00000X | Family Doctor | 5101019252 | MI |
NPI | 1003101411 |
---|---|
Provider Name | Daniel Francis Bouchard |
First Address | Lansing, MI 48912-1811 |
Second Address | Lansing, MI 48912-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 08/10/2015 |