Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2901014129 | MI |
Y | 213EG0000X | General Practice | 2901014129 | MI |
NPI | 1003082439 |
---|---|
Provider Name | Dr. Kelly Jim Rigney |
First Address | South Lyon, MI 48178-7400 |
Second Address | South Lyon, MI 48178-7400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 01/02/2020 |