Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 51014325 | MI |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101014325 | MI |
NPI | 1356360614 |
---|---|
Provider Name | Dr. Steven Christopher Reschak |
First Address | Grand Blanc, MI 48439-2559 |
Second Address | Grand Blanc, MI 48439-2559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 22/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4638591 | (05) | MI |
I17991 | (02) | MI |