Healthcare Provider Details

I. General information

NPI: 1700842010
Provider Name (Legal Business Name): JAMES E YOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 EAGLE PARK DR NE SUITE 100
GRAND RAPIDS MI
49525-4047
US

IV. Provider business mailing address

3230 EAGLE PARK DR NE SUITE 100
GRAND RAPIDS MI
49525-4047
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-2229
  • Fax: 616-988-2010
Mailing address:
  • Phone: 616-988-2229
  • Fax: 616-988-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301063990
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: