Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 13270 | MI |
Y | 1223P0300X | Periodontist | 2901013270 | MI |
NPI | 1013039098 |
---|---|
Provider Name | Michael Haddow |
First Address | Lathrup Village, MI 48076-2701 |
Second Address | Lathrup Village, MI 48076-2701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 07/06/2021 |