Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | SD076611 | MI |
NPI | 1003805607 |
---|---|
Provider Name | Steven A Dunn |
First Address | Muskegon, MI 49440-1045 |
Second Address | Muskegon, MI 49442-5502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 29/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1578703252 | (05) | MI |
H39743 | (02) | |
MI1878 | MEDICARE ID - TYPE UNSPECIFIED (01) | MI |