Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 036079630 | IL |
Y | 207T00000X | Neurosurgeon | 4301071262 | MI |
NPI | 1043275654 |
---|---|
Provider Name | Martin James Buckingham |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 24/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MB044507 | (02) | MI |