Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301074898 | MI |
NPI | 1033158159 |
---|---|
Provider Name | Dr. Marc Headapohl |
First Address | Kalamazoo, MI 49008-4801 |
Second Address | Kalamazoo, MI 49008-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G91181 | (02) | MI |