Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301056522 | MI |
NPI | 1104806678 |
---|---|
Provider Name | Mark E Meyer |
First Address | Kalamazoo, MI 49048-1639 |
Second Address | Kalamazoo, MI 49048-1639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2654120 | (05) | MI |
F10122 | (02) | MI |