Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301069625 | MI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301069625 | MI |
NPI | 1225008790 |
---|---|
Provider Name | Dr. Michael Raphelson |
First Address | Kalamazoo, MI 49007-3881 |
Second Address | Kalamazoo, MI 49007-3881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4194092 | (05) | MI |
4574500 | (05) | MI |
CA4396 | RAILROAD MEDICARE (01) | MI |
H16718 | (02) |