Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1265963029 |
---|---|
Provider Name | Scott Baranek |
First Address | Saginaw, MI 48603-2268 |
Second Address | Saginaw, MI 48603-2268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 23/03/2017 |