Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101013290 | MI |
NPI | 1154306595 |
---|---|
Provider Name | Dr. Kim Mahler |
First Address | Iron River, MI 49935-9526 |
Second Address | Iron River, MI 49935-8507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 09/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4093394 | (05) | MI |
G96566 | (02) |