Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 4301051199 | MI |
NPI | 1083672968 |
---|---|
Provider Name | Marc Gregory Webb |
First Address | Southfield, MI 48076-3713 |
Second Address | Southfield, MI 48076-3713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 24/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F87919 | (02) | MI |