Individual
DR. BRYAN JON PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036-125552
IL
207X00000X
Orthopaedic Surgery Physician
Primary
4301086174
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295944239
—
MI
Enumeration date
05/22/2007
Last updated
03/21/2014
Update your record
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