Healthcare Provider Details

I. General information

NPI: 1285662833
Provider Name (Legal Business Name): JOSPEH B MAROGIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2018
US

IV. Provider business mailing address

1720 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2018
US

V. Phone/Fax

Practice location:
  • Phone: 616-454-8442
  • Fax: 616-454-5044
Mailing address:
  • Phone: 616-454-8442
  • Fax: 616-454-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJM032810
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: