Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 017156 | ME |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 4301078141 | MI |
NPI | 1669422077 |
---|---|
Provider Name | John D Maskill |
First Address | Grand Rapids, MI 49525 |
Second Address | Grand Rapids, MI 49525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 28/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I27185 | (02) | |
I27185 | (02) | ME |