Healthcare Provider Details

I. General information

NPI: 1356342448
Provider Name (Legal Business Name): BAO-MIN TWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 MERCY DR
MUSKEGON MI
49444-4605
US

IV. Provider business mailing address

1277 MERCY DR
MUSKEGON MI
49444-4605
US

V. Phone/Fax

Practice location:
  • Phone: 231-733-1912
  • Fax: 231-737-4603
Mailing address:
  • Phone: 231-733-1912
  • Fax: 231-737-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301048949
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: