Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 4301038705 | MI |
NPI | 1366462350 |
---|---|
Provider Name | Terry R Degroot |
First Address | Grand Haven, MI 49417-2543 |
Second Address | Grand Haven, MI 49417-2543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 13/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B43773 | (02) | MI |