Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301059500 | MI |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 4301059500 | MI |
NPI | 1003850686 |
---|---|
Provider Name | Dr. Jeffrey Charles King |
First Address | Kalamazoo, MI 49007-5359 |
Second Address | Kalamazoo, MI 49007-5359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003850686 | (05) | MI |
110174 | GREAT LAKES HLTH PLN (01) | |
2003905471 | BCBS IND PIN (01) | MI |
200C910540 | BCBS GRP PIN (01) | MI |
4290938-10 | (05) | MI |
5315705 | AETNA PIN (01) | |
G53921 | (02) |