Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 15813 | MN |
Y | 2080P0210X | Pediatric Nephrologist | 15813 | MN |
NPI | 1851661532 |
---|---|
Provider Name | Dr. Alfred F. Michael |
First Address | St. Paul, MN 55116-2820 |
Second Address | St. Paul, MN 55116-2820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AM4434774 | CONTROLLED SUBSTANCE REGISTRATION CERT (01) |