Doctor Name: | DEREK FALK |
NPI Number: | 1073920633 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP |
License Number: | 4704260522 |
Business Practice Address: | 13924 Wadaga Rd Baraga, MI - 499089204 |
Business Phone Number: | 9063537070 |
Business Fax Number: | |
Mailing Address: | 13924 Wadaga Rd, BARAGA |
State: | MI |
Postal Code: | 499089204 |
Phone Number: | 9063537070 |
Fax Number: | |
NPI Enumeration Date: | 07/16/2014 |
NPI Last Update Date: | 07/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 4704260522 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |