Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 4301064959 | MI |
NPI | 1184693418 |
---|---|
Provider Name | John H Marks |
First Address | Kalamazoo, MI 49008-1282 |
Second Address | Kalamazoo, MI 49008-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3503947871 | BCBS (01) | MI |
4200126 | (05) | MI |
D89592 | (02) |