Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901002421 | MI |
Y | 222Z00000X | Podiatrist | 5901002421 | MI |
NPI | 1023305224 |
---|---|
Provider Name | Dr. David Matthew Keizer |
First Address | Canton, MI 48187 |
Second Address | Farmington Hills, MI 48336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2011 |
Last Update Date | 08/07/2011 |