Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 4301079473 | MI |
NPI | 1467411785 |
---|---|
Provider Name | William Mallin |
First Address | Royal Oak, MI 48073-6712 |
Second Address | Troy, MI 48085-1117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4396015 | (05) | MI |
F27431 | (02) | MI |