Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101011191 | MI |
N | 207Q00000X | Family Doctor | 5101011191 | MI |
NPI | 1023091865 |
---|---|
Provider Name | Michael Briggs |
First Address | Palatine, IL 60055-7767 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2005 |
Last Update Date | 10/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4785210 | (05) | MI |
4785229 | (05) | MI |
4785238 | (05) | MI |
F07124 | (02) | MI |
MB011191 | BLUE CROSS BLUE SHIELD (01) |