Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 4301100151 | MI |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 4301100151 | MI |
NPI | 1205197639 |
---|---|
Provider Name | Marcus P Haw |
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 | 01/06/2012 |
Last Update Date | 18/03/2021 |