Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 4301021889 | MI |
NPI | 1316031750 |
---|---|
Provider Name | Mr. John Huntington |
First Address | Battle Creek, MI 49017 |
Second Address | Battle Creek, MI 49017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |