Healthcare Provider Details

I. General information

NPI: 1194305433
Provider Name (Legal Business Name): RAHWANA EYASSU AMARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE STE 100
GRAND RAPIDS MI
49503-5229
US

IV. Provider business mailing address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8000
  • Fax:
Mailing address:
  • Phone: 616-840-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number43015182546
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD492296
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: