MEDICARE: MICHIGAN MEDICAL PATIENT CARE

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1467693838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN MEDICAL PATIENT CARE

Provider Business Mailing Address
First Line	:	4085 BURTON ST SE
Second Line	:	SUITE 200
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 EAST PARIS AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8336
Country	:	US
Telephone Number	:	616-949-3739
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SCOTT HARRING
Credential	:
Telephone Number	:	616-974-4889

Provider Enumeration Date	:	03/16/2009
Last Update Date	:	03/02/2010

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Directions to “MICHIGAN MEDICAL PATIENT CARE ” Practice Location

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