Healthcare Provider Details

I. General information

NPI: 1245869320
Provider Name (Legal Business Name): CAROLINE FOURA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

4100 EMBASSY DR SE
GRAND RAPIDS MI
49546-2416
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-1774
  • Fax:
Mailing address:
  • Phone: 616-988-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101027659
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: