Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2901014950 | MI |
NPI | 1518949742 |
---|---|
Provider Name | Dr. Gregory M Nielsen |
First Address | Huntington Woods, MI 48070-1330 |
Second Address | Huntington Woods, MI 48070-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2915413 | (05) | MI |
U25787 | (02) |