Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 9366 | MI |
NPI | 1033246756 |
---|---|
Provider Name | Ronald Michaelson |
First Address | Dearborn, MI 48124-1924 |
Second Address | Dearborn, MI 48124-1924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |