Basic Information
| Provider Information | |||||||||
| NPI: | 1619968856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIELD | ||||||||
| FirstName: | E | ||||||||
| MiddleName: | MALCOLM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4677 TOWNE CENTRE RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552989888 | ||||||||
| FaxNumber: | 9894973128 | ||||||||
| Practice Location | |||||||||
| Address1: | 4677 TOWNE CENTRE RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552989888 | ||||||||
| FaxNumber: | 9894972138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 4301022285 | MI | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2033412 | 05 | MI | MEDICAID |