Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 133694 | FL |
NPI | 1013111624 |
---|---|
Provider Name | Dr. Michael Seijoon Park |
First Address | Bradenton, FL 34209-3201 |
Second Address | Bradenton, FL 34210-2509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 17/03/2018 |