Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 5101012954 | IL |
Y | 207P00000X | Emergency Physician | 5101012954 | MI |
N | 207PE0004X | Emergency Medical Services | 5101012954 | MI |
NPI | 1164502340 |
---|---|
Provider Name | Jeffrey L Ozan |
First Address | Grand Rapids, MI 49546-2416 |
Second Address | Bay City, MI 48708-6831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 26/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E57249 | (02) | MI |