Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4351045078 | MI |
Y | 208600000X | Surgeon | 4351045078 | MI |
N | 208200000X | Surgeon | R77048 | AZ |
N | 208600000X | Surgeon | R77048 | AZ |
NPI | 1013402874 |
---|---|
Provider Name | Felipe Andres Pacheco Granda |
First Address | Saginaw, MI 48602-5303 |
Second Address | Saginaw, MI 48602-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2018 |
Last Update Date | 13/06/2019 |