Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301046958 | MI |
NPI | 1134178551 |
---|---|
Provider Name | Dr. Steven Mark Kreshover |
First Address | Bingham Farms, MI 48025-4367 |
Second Address | Bingham Farms, MI 48025-4367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 10/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2735649 | (05) | MI |
F06151 | (02) |