Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 4301115622 | MI |
N | 208000000X | Pediatrician | 125067744 | IL |
NPI | 1649653494 |
---|---|
Provider Name | Dr. Peter Nguyen |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2015 |
Last Update Date | 05/07/2018 |