Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | MN005687 | MI |
NPI | 1104815786 |
---|---|
Provider Name | Dr. Michael A Nigro |
First Address | Charlevoix, MI 49720-9501 |
Second Address | Charlevoix, MI 49720-9501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 06/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1035388 | (05) | MI |
E31657 | (02) | MI |