Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5501018239 | MI |
NPI | 1033603188 |
---|---|
Provider Name | Marlon Bayan Nido |
First Address | Sunrise, FL 33323-2869 |
Second Address | Sunrise, FL 33323-2869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2018 |
Last Update Date | 21/06/2018 |