Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 4301059376 | MI |
NPI | 1427090448 |
---|---|
Provider Name | Mark Adams |
First Address | Saginaw, MI 48604-9515 |
Second Address | Saginaw, MI 48604-9515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 17/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4647680 | (05) | MI |
G84457 | (02) | MI |