Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01064837A | IN |
N | 111NI0900X | Internist | 01064837A | IN |
N | 207R00000X | Internist | 4301102195 | MI |
N | 111NI0900X | Internist | 4301102195 | MI |
N | 208000000X | Pediatrician | 4301102195 | MI |
Y | 2080P0214X | Pediatric Pulmonologist | 4301102195 | MI |
NPI | 1538378724 |
---|---|
Provider Name | Dr. Charles Alan Mccaslin |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 01/07/2013 |