Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301072224 | MI |
NPI | 1134137136 |
---|---|
Provider Name | Erik Sievertsen |
First Address | Muskegon, MI 49443 |
Second Address | Muskegon, MI 49443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 19/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
930103748 | RAILROAD MEDICARE (01) | MI |