Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 4301026454 | MI |
NPI | 1245337567 |
---|---|
Provider Name | Dr. David H Van Dyke |
First Address | East Lansing, MI 48824-1315 |
Second Address | East Lansing, MI 48824-1313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B46773 | (02) | MI |