Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 236771 | NY |
N | 207Q00000X | Family Doctor | 31145 | WI |
Y | 207Q00000X | Family Doctor | 4301073557 | MI |
NPI | 1003803313 |
---|---|
Provider Name | Dr. Mark W Lay |
First Address | Cassopolis, MI 49031-1242 |
Second Address | Cassopolis, MI 49031-1242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0803810311 | BCBS IND PIN # (01) | MI |
E29293 | (02) | MI |
LM073557 | BCBS IND BILLING # (01) | MI |