is a Addiction Medicine in Grand Rapids, Michigan. practices all healthcare services and medical treatments related to Addiction Medicine. The NPI Number for is 1588821433. The last update date is .
's current location address is 3001 Fuller Ave Ne, Grand Rapids, Michigan. You can contact this provider via phone number 6163658800 and fax number 6163657979. The mailing address for is 3001 Fuller Ave Ne, Grand Rapids, Michigan. To know further, please read the information below!
Provider Profile Detail
Provider Name | |
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Address | 3001 Fuller Ave Ne, Grand Rapids, Michigan |
Phone Number | 6163658800 |
Fax Number | 6163657979 |
Sole Proprietor | -- |
Credentials | -- |
NPI Number Detail
NPI Number | 1588821433 |
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Provider Enumeration Date | |
Last Updated Date |
Provider Mailing Address Detail
Address | 3001 Fuller Ave Ne |
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City | Grand Rapids |
State | Michigan (MI) |
Post Code | 495053247 |
Phone Number | 6163658800 |
Fax Number | 6163657979 |
Provider's Primary Taxonomy Detail
Speciality | Addiction Medicine |
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Taxonomy | 207Ra0401X |
Licence No | 100005 |
Definition: An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualification |
Provider's Other Legacy Identifiers
Identifier | Identifier Type | Identifier State | Identifier Issuer |
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504118411 | MI | BCBS |
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