Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 4301110922 | MI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 4301110922 | MI |
N | 207NS0135X | Procedural Dermatology | 4301110922 | MI |
NPI | 1437380102 |
---|---|
Provider Name | Dr. Adam D Asarch |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Grand Rapids, MI 49546-3670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2009 |
Last Update Date | 10/09/2021 |