Healthcare Provider Details

I. General information

NPI: 1114012978
Provider Name (Legal Business Name): FRANK R LOVELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MICHIGAN ST NE STE 300
GRAND RAPIDS MI
49503-2524
US

IV. Provider business mailing address

PO BOX 289
JENISON MI
49429-0289
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-5700
  • Fax: 616-391-8612
Mailing address:
  • Phone: 616-457-9000
  • Fax: 616-457-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number025832
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: