Healthcare Provider Details

I. General information

NPI: 1407542780
Provider Name (Legal Business Name): LILIET PERTIERRA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MICHIGAN ST NE STE 3003
GRAND RAPIDS MI
49503-2528
US

IV. Provider business mailing address

35 MICHIGAN ST NE STE 3003
GRAND RAPIDS MI
49503-2528
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-2200
  • Fax:
Mailing address:
  • Phone: 616-267-2200
  • Fax: 616-267-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number5101029524
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: