Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1750841037 |
---|---|
Provider Name | Mark Degroff |
First Address | Waterford, MI 48327-1409 |
Second Address | Waterford, MI 48327-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2019 |
Last Update Date | 22/03/2019 |