Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 02146 | MI |
NPI | 1427728054 |
---|---|
Provider Name | Mr. Lawrence M Bugg |
First Address | Flint, MI 48507-1107 |
Second Address | Flint, MI 48507-1107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 17/09/2021 |