Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301067122 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301067122 | MI |
NPI | 1245312917 |
---|---|
Provider Name | Dr. Mark W Bates |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Byron Center, MI 49315-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 10/03/2021 |