Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301036544 | MI |
NPI | 1124036124 |
---|---|
Provider Name | Henry Hammersmith |
First Address | Chicago, IL 60689-0001 |
Second Address | Grand Rapids, MI 49503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 16/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110050654 | RAILROAD MEDICARE (01) | MI |
B43750 | (02) | MI |