Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 4301051766 | MI |
Y | 207RP1001X | Pulmonary Disease | MI4301051766 | MI |
N | 207RS0012X | Sleep Medicine | 4301051766 | MI |
NPI | 1023054772 |
---|---|
Provider Name | Dr. Mark R. Villeneuve |
First Address | Livonia, MI 48154-5083 |
Second Address | Livonia, MI 48154-5083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 21/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4200387 | (05) | MI |
F81558 | (02) | MI |