Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 4301076050 | MI |
N | 207QA0401X | Family Doctor - Addiction Medicine | 4301076050 | MI |
NPI | 1720006224 |
---|---|
Provider Name | Michael T Okumura |
First Address | Saginaw, MI 48638-5849 |
Second Address | Augusta, MI 49012-9500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 18/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (02) | |
PENDING | (05) | TN |