Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301026293 | MI |
NPI | 1023085784 |
---|---|
Provider Name | Hugo K Roesler |
First Address | Kalamazoo, MI 49008-2015 |
Second Address | Kalamazoo, MI 49001-2652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 10/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10 1352590 | (05) | MI |
10 30606 | PHYSICIANS HEALTH PLAN (01) | MI |
12126 | HEALTH PLAN OF MI (01) | MI |
A77983 | (02) |