Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 009715 | MI |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101-009715 | MI |
N | 207Q00000X | Family Doctor | 009715 | MI |
NPI | 1346278694 |
---|---|
Provider Name | Dr. David N Grimshaw |
First Address | Lansing, MI 48906 |
Second Address | Lansing, MI 48906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 05/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4459812 | (05) | MI |
E89436 | (02) | MI |