Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 4301023367 | MI |
NPI | 1730178898 |
---|---|
Provider Name | Marshall Blondy |
First Address | Bingham Farms, MI 48025-4367 |
Second Address | Bingham Farms, MI 48025-4367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 07/02/2011 |