Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301032660 | MI |
Y | 208600000X | Surgeon | 4301032660 | MI |
NPI | 1013988898 |
---|---|
Provider Name | Dr. Mohan Dass Macha |
First Address | Marlette, MI 48453 |
Second Address | Marlette, MI 48453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0267690362 | BLUE CROSS (01) | MI |
1050366 | (05) | MI |
B46283 | (02) |