Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901015336 | MI |
NPI | 1073506390 |
---|---|
Provider Name | Dr. Jeffrey Allen Lindhout |
First Address | Grandville, MI 49418-2349 |
Second Address | Grandville, MI 49418-2349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 16/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3057811 | (05) | MI |
3057820 | (05) | MI |
U56582 | (02) | MI |