Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D11635 | MN |
NPI | 1912996802 |
---|---|
Provider Name | Michael Downie |
First Address | Woodbury, MN 55125-9406 |
Second Address | Woodbury, MN 55125-9406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 08/07/2020 |