Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 35063285 | OH |
NPI | 1104896521 |
---|---|
Provider Name | Michael Charles Stump |
First Address | Findlay, OH 45840-3618 |
Second Address | Findlay, OH 45840-3618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0920552 | (05) | OH |
F49977 | (02) |