Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 4301053164 | MI |
NPI | 1053411215 |
---|---|
Provider Name | Dr. John Glenn Anema |
First Address | Grand Rapids, MI 49503-2515 |
Second Address | Grand Rapids, MI 49503-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 14/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4218695 | (05) | MI |
H14420 | (02) | MI |