is a General Practice in Grand Rapids, Michigan. practices all healthcare services and medical treatments related to General Practice. The NPI Number for is 1104083179. The last update date is .
's current location address is 3700 52nd St Se, Grand Rapids, Michigan. You can contact this provider via phone number 6166563700 and fax number 6166563701. The mailing address for is 3700 52nd St Se, Grand Rapids, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 3700 52nd St Se, Grand Rapids, Michigan |
| Phone Number | 6166563700 |
| Fax Number | 6166563701 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1104083179 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 3700 52nd St Se |
|---|---|
| City | Grand Rapids |
| State | Michigan (MI) |
| Post Code | 495129637 |
| Phone Number | 6166563700 |
| Fax Number | 6166563701 |
Provider's Primary Taxonomy Detail
| Speciality | General Practice |
|---|---|
| Taxonomy | 208D00000X |
| Licence No | 5101012527 |
|
Definition: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 5330177 | MI | BLUE CROSS/BLUE SHIELD | |
| 01-00603 | MI | PHYSICIANS HEALTH PLAN OF MID |
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