Healthcare Provider Details

I. General information

NPI: 1205357365
Provider Name (Legal Business Name): ZEYNEP DEMIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-8614
US

IV. Provider business mailing address

221 MICHIGAN ST NE STE 402
GRAND RAPIDS MI
49503-2538
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3245
  • Fax:
Mailing address:
  • Phone: 616-391-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301113408
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: