Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301031477 | MI |
N | 111NI0900X | Internist | 4301031477 | MI |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 4301031477 | MI |
NPI | 1093747404 |
---|---|
Provider Name | Douglas D Notman |
First Address | Grand Rapids, MI 49503-4328 |
Second Address | Grand Rapids, MI 49503-4650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 04/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4308095 | (05) | MI |
4880086 | (05) | MI |
B46846 | (02) | MI |