Healthcare Provider Details

I. General information

NPI: 1366291064
Provider Name (Legal Business Name): NERMIEN MOUSTAFA KANDEEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 12/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHERRY ST SE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

200 JEFFERSON AVE SE JEFFERSON BLDG, SUITE 305
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5050
  • Fax:
Mailing address:
  • Phone: 616-685-6774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4351052977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: