Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5315057954 | MI |
NPI | 1003127028 |
---|---|
Provider Name | Spring L Madosh |
First Address | Laurium, MI 49913-2134 |
Second Address | Laurium, MI 49913-2134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 04/09/2013 |