Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12764 | MI |
Y | 213EG0000X | General Practice | 12764 | MI |
NPI | 1003895723 |
---|---|
Provider Name | Dr. Frank Alley |
First Address | Portage, MI 49024-5090 |
Second Address | Portage, MI 49024-5090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 08/07/2007 |