Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301049510 | MI |
NPI | 1023089083 |
---|---|
Provider Name | Michael R. Demers |
First Address | Saint Clair Shores, MI 48080-3207 |
Second Address | St Clair Shores, MI 48080-3207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 19/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1916087 | (05) | MI |
A73719 | (02) | MI |