Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301083065 | MI |
NPI | 1033140868 |
---|---|
Provider Name | Steve R Klafeta |
First Address | Grand Rapids, MI 49503-4328 |
Second Address | Grand Rapids, MI 49503-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4606453 | (05) | MI |
4879020 | (05) | MI |
I08063 | (02) | MI |