Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301405922 | MI |
N | 208000000X | Pediatrician | 4301405922 | MI |
NPI | 1104915032 |
---|---|
Provider Name | Marc S Mcmorris |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48105-9484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 22/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3048080 | (05) | MI |
F01759 | (02) | MI |