Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | GK012039 | MI |
NPI | 1003924820 |
---|---|
Provider Name | Gary S Kwartowitz |
First Address | Clarkston, MI 48346-3198 |
Second Address | Clarkston, MI 48346-3198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 16/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3477100 | (05) | MI |
GK012039 | (02) | MI |
OM705700 | (02) | MI |