Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 48646-20 | WI |
Y | 208600000X | Surgeon | 48646-20 | WI |
NPI | 1003984014 |
---|---|
Provider Name | Mary-Beth M Limback |
First Address | Iron Mountain, MI 49801-4760 |
Second Address | Iron Mountain, MI 49801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 12/12/2018 |