MEDICARE: MICHIGAN MEDICAL, PC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750443511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN MEDICAL, PC.

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	:	616-974-4889
Fax Number	:	616-974-4582

Provider Business Practice Location Address
First Line	:	3800 LAKE MICHIGAN DR NW
Second Line	:	SUITE A
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4583
Country	:	US
Telephone Number	:	616-453-8225
Fax Number	:

Authorized Official
Title or Position	:	VP OF FINANCE AND REIMBURSEMENT
Name	:	DANIEL GREVENGOED
Credential	:
Telephone Number	:	616-974-4889

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/22/2020

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