Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | SR038657 | MI |
NPI | 1073589446 |
---|---|
Provider Name | Steven M Rapp |
First Address | Waterford, MI 48327-1913 |
Second Address | Waterford, MI 48327-1913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 08/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1406338431 | BCBSM (01) | MI |
3186514 | (05) | MI |
A75357 | (02) | MI |