Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301065831 | MI |
Y | 208600000X | Surgeon | 4301065831 | MI |
NPI | 1003871559 |
---|---|
Provider Name | Kevin M Markham |
First Address | Petoskey, MI 49770-2266 |
Second Address | Petoskey, MI 49770-2266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 19/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020B41012 | BCBS MI (01) | MI |
0B41012 | BCN (01) | MI |
4320358 | (05) | MI |
H42036 | (02) | MI |
P00117059 | RAILROAD MEDICARE (01) | MI |