Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 4301407190 | MI |
Y | 208200000X | Surgeon | 4301407190 | MI |
Y | 208600000X | Surgeon | 4301407190 | MI |
N | 2086S0102X | Surgical Critical Care | 4301407190 | FM |
NPI | 1134220049 |
---|---|
Provider Name | Jeffrey D Punch |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3057482 | (05) | MI |
F81503 | (02) | MI |