Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 5101006719 | MI |
N | 2080A0000X | Adolescent Medicine | 34345 | MO |
NPI | 1124129689 |
---|---|
Provider Name | James Michael Carl |
First Address | Grand Rapids, MI 49546 |
Second Address | Grand Rapids, MI 49546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 30/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E49610 | (02) |