Healthcare Provider Details

I. General information

NPI: 1700456662
Provider Name (Legal Business Name): MUHAMMAD REHAN AWAIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE AVE SE STE 3000
GRAND RAPIDS MI
49503-4692
US

IV. Provider business mailing address

300 LAFAYETTE AVE SE STE 3000
GRAND RAPIDS MI
49503-4692
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6919
  • Fax: 616-685-3063
Mailing address:
  • Phone: 616-685-6919
  • Fax: 616-685-3063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351048066
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: