Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301100732 | MI |
N | 208600000X | Surgeon | 4301100732 | MI |
Y | 2086S0102X | Surgical Critical Care | 4301100732 | MI |
NPI | 1346503455 |
---|---|
Provider Name | Dr. Matthew Brent Dull |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 30/04/2021 |