Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01065423A | IN |
NPI | 1114131919 |
---|---|
Provider Name | Dr. Brett Galley |
First Address | Detroit, MI 48278-1076 |
Second Address | Crown Point, IN 46307-8481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 14/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-112864 | STATE MEDICAL LICENSE (01) | IL |