Healthcare Provider Details

I. General information

NPI: 1417216896
Provider Name (Legal Business Name): EMILY ENGLISH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 CASCADE RD SE
GRAND RAPIDS MI
49546-2149
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9686
US

V. Phone/Fax

Practice location:
  • Phone: 901-361-7014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number4301110617
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: