Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 4301071354 | MI |
N | 208000000X | Pediatrician | 4301071354 | MI |
N | 2080P0203X | Pediatric Critical Care Doctor | 4301071354 | MI |
NPI | 1265404495 |
---|---|
Provider Name | John W Winters |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 22/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F41234 | (02) | MI |