Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 048654 | MI |
Y | 208600000X | Surgeon | 048654 | MI |
NPI | 1013943877 |
---|---|
Provider Name | William L Kestenberg |
First Address | Farmington Hills, MI 48334-3292 |
Second Address | Farmington Hills, MI 48334-1566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 23/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013943877 | (05) | MI |
700H273300 | BCBS MI (01) | MI |
E49548 | (02) |