Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301072162 | MI |
NPI | 1073556759 |
---|---|
Provider Name | Dr. Kevin Monfette |
First Address | Metamora, MI 48455 |
Second Address | Southfield, MI 48075-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34069 | (02) | MI |
KM072162 | BC/BS OF MICHIGAN (01) | MI |