| Grand Rapids Addiction Medicine Specialists Pc | |
|
4100 Lake Dr Se Suite 305 Grand Rapids MI 49546-8292 | |
| (616) 954-0600 | |
| (616) 954-1675 |
| Full Name | Grand Rapids Addiction Medicine Specialists Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4100 Lake Dr Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Khan Javan Nedd (PRESIDENT) |
| Authorized Official Contact | 6169540600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Rapids Addiction Medicine Specialists Pc Po Box 1682 Grand Rapids MI 49501-1682 Ph: (616) 954-0600 | Grand Rapids Addiction Medicine Specialists Pc 4100 Lake Dr Se Suite 305 Grand Rapids MI 49546-8292 Ph: (616) 954-0600 |
| NPI Number | 1780642355 |
|---|---|
| Provider Enumeration Date | 05/03/2006 |
| Last Update Date | 07/31/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780642355 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301047295 (Michigan) | Primary |
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