Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC001916L | PA |
NPI | 1538403563 |
---|---|
Provider Name | Michael Harold Innes |
First Address | Camp Hill, PA 17011-1049 |
Second Address | Millersburg, PA 17061-9367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |