Doctor Name: | MARSHALL HLATKO |
NPI Number: | 1013309608 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RN |
License Number: | 4704127200 |
Business Practice Address: | 610 S Burdick St Kalamazoo, MI - 490075221 |
Business Phone Number: | 2693813700 |
Business Fax Number: | 2693813810 |
Mailing Address: | 610 S Burdick St, KALAMAZOO |
State: | MI |
Postal Code: | 490075221 |
Phone Number: | 2693813700 |
Fax Number: | 2693813810 |
NPI Enumeration Date: | 02/19/2015 |
NPI Last Update Date: | 02/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0809X |
License Number: | 4704127200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health, Adult |
Taxonomy Definition: |