Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ML064096 | MI |
NPI | 1013993674 |
---|---|
Provider Name | Mark W Lenters |
First Address | Holland, MI 49423-4944 |
Second Address | Holland, MI 49423-4944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4092726 | (05) | MI |
G71416 | (02) |