Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MG072049 | MI |
NPI | 1023184819 |
---|---|
Provider Name | Mark V Galan |
First Address | Traverse City, MI 49684-7331 |
Second Address | Traverse City, MI 49684-7331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2006 |
Last Update Date | 29/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4596099 | (05) | MI |
I07877 | (02) | MI |
OB81010 | BCBSM (01) | MI |