Individual
MR. JOHN J BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1234 DONOTKNOW, ANN ARBOR, MI 48103
(989) 123-4567
Mailing address
1234 DONOTKNOW, ANN ARBOR, MI 48103
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301027296
MI
Other
Enumeration date
11/17/2005
Last updated
11/23/2007
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