Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2301007051 | MI |
N | 111NI0013X | Independent Medical Examiner | DC23160 | CA |
NPI | 1154574028 |
---|---|
Provider Name | Dr. Gerard Edward Farage |
First Address | Grand Rapids, MI 49525-2440 |
Second Address | Grand Rapids, MI 49525-2440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 13/05/2016 |