Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 4301029539 | MI |
NPI | 1265414189 |
---|---|
Provider Name | Dr. Thomas D Magnell |
First Address | Beverly Hills, MI 48025-3127 |
Second Address | Beverly Hills, MI 48025-3127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 23/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083563 | (05) | MI |
B44632 | (02) |