Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | HM002127 | MI |
NPI | 1003875832 |
---|---|
Provider Name | Dr. Hengelberth D Montufar |
First Address | Richmond, MI 48062-1937 |
Second Address | Richmond, MI 48062-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 09/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4824819 | (05) | MI |
V06361 | (02) | MI |