Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 4301041260 | MI |
NPI | 1194965335 |
---|---|
Provider Name | Filemon Jose Inocencio |
First Address | Berrien Springs, MI 49103-9654 |
Second Address | Berrien Springs, MI 49103-9654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2009 |
Last Update Date | 28/02/2009 |