Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101010677 | MI |
NPI | 1013964337 |
---|---|
Provider Name | Dr. Howard Fertel |
First Address | Commerce Township, MI 48390-1306 |
Second Address | Southfield, MI 48075-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 21/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114316542 | (05) | MI |
114441513 | (05) | MI |
114441522 | (05) | MI |
F31066 | (02) | MI |
HF010677 | BC/BS OF MICHIGAN (01) | MI |