MEDICARE: JAMES V HIGGINS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1326178104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES V HIGGINS PHD

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-643-9143
Fax Number	:	616-774-7699

Provider Business Practice Location Address
First Line	:	1345 MONROE AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4671
Country	:	US
Telephone Number	:	616-391-7568
Fax Number	:	616-391-7599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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