Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 4301052816 | MI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 4301052816 | MI |
N | 207ND0900X | Dermatopathologist | 4301052816 | MI |
N | 207NS0135X | Procedural Dermatology | 4301052816 | MI |
NPI | 1154368165 |
---|---|
Provider Name | Mark Allyn Stiff |
First Address | Southfield, MI 48034-1700 |
Second Address | Southfield, MI 48034-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 17/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3341836 | (05) | MI |
F07114 | (02) | MI |