Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1225282577 |
---|---|
Provider Name | Mr. Michael Thomas Bacigalupo |
First Address | Saginaw, MI 48604-8202 |
Second Address | Saginaw, MI 48604-8202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 13/11/2008 |