Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101018598 | MI |
NPI | 1174556880 |
---|---|
Provider Name | Dr. Arthur Moeller JR. |
First Address | Madison Heights, MI 48071-3487 |
Second Address | Madison Heights, MI 48071-3487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 20/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S48128 | (02) | CO |