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1179 E Paris Ave Se Ste. 220 Grand Rapids MI 49546-8371 | |
| (616) 454-2004 | |
| (616) 454-0061 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1179 E Paris Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Polly (pauline) Krywanski (SVP - FINANCE) |
| Authorized Official Contact | 6164862253 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 Michigan St Ne Mc845 Grand Rapids MI 49503-2560 Ph: () - | 1179 E Paris Ave Se Ste. 220 Grand Rapids MI 49546-8371 Ph: (616) 454-2004 |
| NPI Number | 1144505058 |
|---|---|
| Provider Enumeration Date | 10/12/2011 |
| Last Update Date | 10/27/2023 |
| Certification Date | 10/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144505058 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | (* (Not Available)) | Secondary |
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