Healthcare Provider Details

I. General information

NPI: 1194906503
Provider Name (Legal Business Name): MIRIAM ENGLER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 CASCADE RD SE
GRAND RAPIDS MI
49546-3666
US

IV. Provider business mailing address

4519 CASCADE RD SE
GRAND RAPIDS MI
49546-3666
US

V. Phone/Fax

Practice location:
  • Phone: 616-308-3940
  • Fax: 899-731-0041
Mailing address:
  • Phone: 616-308-3940
  • Fax: 899-731-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6801058792
License Number StateMI

VIII. Authorized Official

Name: MRS. MIRIAM E ENGLER
Title or Position: PRESIDENT
Credential: LMSW
Phone: 616-308-3940