Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 2301005304 | MI |
NPI | 1528062080 |
---|---|
Provider Name | Dr. Jeffrey Charles Duchene |
First Address | Clinton Township, MI 48035-2508 |
Second Address | Clinton Township, MI 48035-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T33153 | (02) |