Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | GM054275 | MI |
NPI | 1003819400 |
---|---|
Provider Name | Dr. Glenn E Merz |
First Address | Muskegon, MI 49443-1848 |
Second Address | Muskegon, MI 49442-5543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 03/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F10099 | (02) |