Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101020411 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 5101020411 | MI |
NPI | 1114366499 |
---|---|
Provider Name | Dr. Nathan James Fitton |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-5353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114366499 | (05) | MI |