Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 5101022858 | MI |
NPI | 1003269911 |
---|---|
Provider Name | John Swan |
First Address | Garden City, MI 48135-4001 |
Second Address | Garden City, MI 48135-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2016 |
Last Update Date | 14/07/2016 |