Healthcare Provider Details

I. General information

NPI: 1942099023
Provider Name (Legal Business Name): DURELL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 MICHIGAN ST NE STE A
GRAND RAPIDS MI
49506-1266
US

IV. Provider business mailing address

2815 MICHIGAN ST NE STE A
GRAND RAPIDS MI
49506-1266
US

V. Phone/Fax

Practice location:
  • Phone: 616-855-7718
  • Fax: 616-855-2977
Mailing address:
  • Phone: 616-855-7718
  • Fax: 616-855-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN MICHAEL DURELL
Title or Position: OWNER
Credential: MTOM, LAC
Phone: 616-828-9546