Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 5101021609 | MI |
N | 208600000X | Surgeon | 5101021609 | MI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 5151010443 | MI |
NPI | 1326425059 |
---|---|
Provider Name | John A Bates |
First Address | Farmington Hills, MI 48336-5919 |
Second Address | Farmington Hills, MI 48336-5919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2015 |
Last Update Date | 08/04/2020 |