Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MP035201 | MI |
NPI | 1043274814 |
---|---|
Provider Name | Mark I Pensler |
First Address | Wyandotte, MI 48192-4668 |
Second Address | Wyandotte, MI 48192-4668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 03/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0820146 | (05) | MI |
B43230 | (02) | MI |