Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 4301036694 | MI |
NPI | 1023009347 |
---|---|
Provider Name | Dr. David J Kearney |
First Address | Troy, MI 48098-6365 |
Second Address | Troy, MI 48098-6365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1904166 | (05) | MI |
B44238 | (02) |