Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 5101016375 | MI |
NPI | 1013130053 |
---|---|
Provider Name | Dr. Brian Jon Macfalda |
First Address | Marquette, MI 49855-2252 |
Second Address | Marquette, MI 49855-2705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013130053 | (05) | MI |