Healthcare Provider Details

I. General information

NPI: 1023901733
Provider Name (Legal Business Name): DOLE CHAU TRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON AVE SE STE 305
GRAND RAPIDS MI
49503-4502
US

IV. Provider business mailing address

15 OTTAWA AVE NW APT 910
GRAND RAPIDS MI
49503-4838
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6741
  • Fax:
Mailing address:
  • Phone: 714-553-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351054802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: