Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 4301056308 | MI |
N | 2086S0105X | Surgery of the Hand | 4301056308 | MI |
NPI | 1447241716 |
---|---|
Provider Name | Dr. Joseph Michael Failla |
First Address | Jenison, MI 49429-0523 |
Second Address | Southfield, MI 48034-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 15/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4579089 | (05) | MI |
540F324290 | BCBS DME PIN (01) | MI |
A61591 | (02) | MI |