Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 35-04-8464-M | OH |
NPI | 1114983152 |
---|---|
Provider Name | Dr. Michael James Marvin |
First Address | North Canton, OH 44720-8803 |
Second Address | Canton, OH 44718-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A84517 | (02) |