Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301086932 | MI |
N | 208600000X | Surgeon | 4301086932 | MI |
Y | 2086S0129X | Vascular Surgeon | 4301086932 | MI |
NPI | 1053411793 |
---|---|
Provider Name | Enrique Criado-Pallares |
First Address | Midland, MI 48640 |
Second Address | Midland, MI 48640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 03/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E39756 | (02) | MI |