Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | BG079468 | MI |
NPI | 1194771873 |
---|---|
Provider Name | Mr. Brian Gelb |
First Address | Charlevoix, MI 49720-1187 |
Second Address | Petoskey, MI 49770-7627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 09/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104392830 | (05) | MI |
H60145 | (02) |