Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 4301056481 | MI |
Y | 207RR0500X | Rheumatology | AM056481 | MI |
NPI | 1043295066 |
---|---|
Provider Name | Dr. Algimantas P Maciulis |
First Address | Bay City, MI 48706 |
Second Address | Bay City, MI 48706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 07/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1100975472 | BCR & BCN (01) | MI |
2678097 | (05) | MI |
C64638 | (02) |