Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301067029 | MI |
NPI | 1043385784 |
---|---|
Provider Name | Fredrick S. Junn |
First Address | Southfield, MI 48034 |
Second Address | Dearborn, MI 48124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FJ067029 | COMMERCIAL-COMMERCIAL NUMBER (01) | |
G23885 | (02) |