Healthcare Provider Details

I. General information

NPI: 1649294091
Provider Name (Legal Business Name): COLLEEN ANNE-CURCIO APP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 KENMOOR AVE SE SUITE 102
GRAND RAPIDS MI
49546-8626
US

IV. Provider business mailing address

630 KENMOOR AVE SE SUITE 102
GRAND RAPIDS MI
49546-8626
US

V. Phone/Fax

Practice location:
  • Phone: 616-920-0825
  • Fax: 616-920-0830
Mailing address:
  • Phone: 616-920-0825
  • Fax: 616-920-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301070786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: