Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 4301074491 | MI |
NPI | 1700863859 |
---|---|
Provider Name | Michael Thomas Mcavoy |
First Address | Saginaw, MI 48603-2108 |
Second Address | Saginaw, MI 48603-2108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 03/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I09072 | (02) |