Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 4301035591 | MI |
N | 208000000X | Pediatrician | 4301035591 | MI |
N | 2080P0201X | Pediatric Allergist | 4301035591 | MI |
Y | 2080P0214X | Pediatric Pulmonologist | 4301035591 | MI |
NPI | 1417939778 |
---|---|
Provider Name | Martin E Hurwitz |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 23/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1417939778 | (05) | MI |
D90176 | (02) |