Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 4301061983 | MI |
NPI | 1750330650 |
---|---|
Provider Name | Paul A Luce |
First Address | Grand Rapids, MI 49503-4607 |
Second Address | Grand Rapids, MI 49503-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4075832 | (05) | MA |
G90379 | (02) | MI |