Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101015391 | MI |
NPI | 1598980773 |
---|---|
Provider Name | Dr. Paul Henri Belanger |
First Address | Muskegon, MI 49444 |
Second Address | Norton Shores, MI 49444-7789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040E061920 | BLUE SHIELD GROUP (01) | MI |
0457410884 | BLUE SHIELD PIN (01) | MI |
5195675 | (05) | MI |