Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 4301042801 | MI |
NPI | 1144237454 |
---|---|
Provider Name | Seth Malin |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4677179 | (05) | MI |
E41974 | (02) | MI |