Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 072794 | MI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301072794 | MI |
NPI | 1427000249 |
---|---|
Provider Name | Michael S. Minasian |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Byron Center, MI 49315-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 18/02/2021 |