Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 4301067380 | MI |
NPI | 1043208358 |
---|---|
Provider Name | Marcus Rhem |
First Address | Jackson, MI 49202-3196 |
Second Address | Lansing, MI 48912-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 20/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180027029 | RAILROAD MEDICARE (01) | |
180C846310 | BCBSM (01) | MI |
180F373640 | BCBSM (01) | MI |
180H149970 | BCBSM (01) | MI |
3250446 | (05) | MI |
G08856 | (02) |