Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 4301041337 | MI |
NPI | 1295826006 |
---|---|
Provider Name | Dr. Dennis Edward Mcgeath |
First Address | Petoskey, MI 49770-9416 |
Second Address | Petoskey, MI 49770-9416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 12/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1998799 | (05) | MI |
B48996 | (02) | MI |