Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301098972 | MI |
N | 2080P0210X | Pediatric Nephrologist | 4301098972 | MI |
NPI | 1891081972 |
---|---|
Provider Name | Mary Bridget Avendt-Reeber |
First Address | Kalamazoo, MI 49048-1623 |
Second Address | Portage, MI 49024-7422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 05/06/2020 |