Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2901011903 | MI |
NPI | 1447233663 |
---|---|
Provider Name | Dr. Michael E Heath |
First Address | Huntington Woods, MI 48070-1330 |
Second Address | Huntington Woods, MI 48070-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T82839 | (02) |