Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 4301077123 | MI |
NPI | 1053413856 |
---|---|
Provider Name | Dr. Michelle Mascarinas Manalac |
First Address | Grand Rapids, MI 49506-3052 |
Second Address | Bad Axe, MI 48413-9630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4427087 | (05) | MI |
H67219 | (02) | MI |