Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 4301076130 | MI |
NPI | 1326197625 |
---|---|
Provider Name | Dr. James Michael Decou |
First Address | Grand Rapids, MI 49503-2556 |
Second Address | Grand Rapids, MI 49503-2556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4201571 | (05) | MI |