Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 4301046601 | MI |
NPI | 1003885054 |
---|---|
Provider Name | Martin B Draznin |
First Address | Kalamazoo, MI 49008-1282 |
Second Address | Kalamazoo, MI 49008-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 24/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3503901841 | BCBS (01) | |
4200082 | (05) | MI |
B22368 | (02) |