Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101004404 | MI |
NPI | 1598862823 |
---|---|
Provider Name | Dr. Robert C Ward |
First Address | East Lansing, MI 48824-1315 |
Second Address | East Lansing, MI 48824-1313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 02/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3317705 | (05) | MI |
E26703 | (02) |