Healthcare Provider Details

I. General information

NPI: 1376281568
Provider Name (Legal Business Name): MATTHEW JOHN HARDER PHD, MGCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MICHIGAN ST NE STE 2200
GRAND RAPIDS MI
49503-2562
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-6218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number7201000439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: