Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301037505 | MI |
N | 111NI0900X | Internist | 4301037505 | MI |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 4301037505 | MI |
NPI | 1073544870 |
---|---|
Provider Name | John D Faichney |
First Address | Traverse City, MI 49684-2342 |
Second Address | Traverse City, MI 49684-2342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3493776 | (05) | MI |
4878542 | (05) | MI |
4964551 | (05) | MI |
B44995 | (02) | MI |