Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2901014699 | MI |
Y | 213EG0000X | General Practice | 2901014699 | MI |
NPI | 1003900226 |
---|---|
Provider Name | Dr. Todd Charlick |
First Address | Brighton, MI 48116-1902 |
Second Address | Brighton, MI 48116-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |