Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | MB000027 | MI |
NPI | 1912086281 |
---|---|
Provider Name | Mike Bain |
First Address | Saginaw, MI 48603-0649 |
Second Address | Saginaw, MI 48604-9435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 11/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4296145 | (05) | MI |
MB000027 | STATE LICENCE (01) | MI |