Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | MM013787 | MI |
N | 204E00000X | Oral & Maxillofacial Surgeon | MM013787 | MI |
NPI | 1427113042 |
---|---|
Provider Name | Dr. Mark S Medel |
First Address | Owosso, MI 48867 |
Second Address | Owosso, MI 48867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9757860390 | BCBSM (01) | MI |
T82893 | (02) |