Healthcare Provider Details

I. General information

NPI: 1114760063
Provider Name (Legal Business Name): MARGARET ENGBERG CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 COMMERCE AVE SW
GRAND RAPIDS MI
49503-4101
US

IV. Provider business mailing address

320 COMMERCE AVE SW
GRAND RAPIDS MI
49503-4101
US

V. Phone/Fax

Practice location:
  • Phone: 616-222-4570
  • Fax:
Mailing address:
  • Phone: 616-222-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: