Healthcare Provider Details

I. General information

NPI: 1851378657
Provider Name (Legal Business Name): CHAD UPTIGROVE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 FARR RD
FRUITPORT MI
49415-8779
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-2900
  • Fax: 231-672-2901
Mailing address:
  • Phone: 231-672-2900
  • Fax: 231-672-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: