Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301037351 | MI |
NPI | 1003804592 |
---|---|
Provider Name | Dr. Charles D Bukrey |
First Address | Grand Rapids, MI 49525-6406 |
Second Address | Grand Rapids, MI 49525-6406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 15/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1258113 | (05) | MI |
E35390 | (02) |