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>> Pediatrics >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1174572671

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 616-784-9400  Fax: 616-784-5167

Contact information for business:
Tel: 616-784-9400  Fax: 616-784-5167

Registration Information:
NPI: 1174572671
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y208000000XAllopathic & Osteopathic Physicians

Legacy codes, insurance codes and state license numbers:



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