Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0844 | MI |
Y | 222Z00000X | Podiatrist | 0844 | MI |
NPI | 1033109178 |
---|---|
Provider Name | Dr. Gary Mauro |
First Address | Warren, MI 48092-3790 |
Second Address | Warren, MI 48092-3790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 30/05/2012 |