Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301007955 | MI |
NPI | 1427111483 |
---|---|
Provider Name | Dr. Michael Krygier |
First Address | Novi, MI 48375-2404 |
Second Address | Novi, MI 48375-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 05/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255511184 | GROUP NPI (01) | MI |