Healthcare Provider Details

I. General information

NPI: 1760503213
Provider Name (Legal Business Name): LIONEL J HURD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SHELDON BLVD SE
GRAND RAPIDS MI
49503-4224
US

IV. Provider business mailing address

4840 MAPLE SHADE CT NE
ROCKFORD MI
49341-7447
US

V. Phone/Fax

Practice location:
  • Phone: 616-776-2400
  • Fax: 616-776-2401
Mailing address:
  • Phone: 616-866-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301027605
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: