Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5101017764 | MI |
N | 111NI0900X | Internist | 5101017764 | MI |
NPI | 1003078023 |
---|---|
Provider Name | Matthew Aaron Erck |
First Address | Wyoming, MI 49519-9606 |
Second Address | Wyoming, MI 49519-9606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 07/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003078023 | (05) | MI |
MI4647010 | (02) | MI |