Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301089502 | MI |
N | 111NI0900X | Internist | 4301089502 | MI |
Y | 207RH0000X | Hematologist | 4301089502 | MI |
N | 207RX0202X | Medical Oncology | 4301089502 | MI |
NPI | 1285833954 |
---|---|
Provider Name | John Martin Magenau IV |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 23/11/2020 |