Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5315060764 | MI |
Y | 207Q00000X | Family Doctor | 5315060764 | MI |
NPI | 1225476385 |
---|---|
Provider Name | Michelle Klink |
First Address | Okemos, MI 48864-6932 |
Second Address | Okemos, MI 48864-6932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 19/05/2020 |