Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301092852 | MI |
N | 208600000X | Surgeon | 4301092852 | MI |
Y | 2086S0102X | Surgical Critical Care | 4301092852 | MI |
NPI | 1083877120 |
---|---|
Provider Name | Patricia Anne Pentiak |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 25/02/2021 |