Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1346271640 |
---|---|
Provider Name | Mr. Rex Windsor Miller |
First Address | Flint, MI 48532-5417 |
Second Address | Flint, MI 48532-5417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4264132 | (05) | MI |
850B50516 | BC/BS (01) | MI |