Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 104853 | MO |
Y | 207RC0000X | Internist - Cardiovascular Disease | 4301115814 | MI |
NPI | 1003812926 |
---|---|
Provider Name | Dr. Dennis L Disch |
First Address | Niles, MI 49120-2207 |
Second Address | Niles, MI 49120-2207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 04/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208700203 | (05) | MO |