Healthcare Provider Details

I. General information

NPI: 1831131226
Provider Name (Legal Business Name): MICHAEL R. JARVIS, DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4047 SALADIN DR SE
GRAND RAPIDS MI
49546-6249
US

IV. Provider business mailing address

4047 SALADIN DR SE
GRAND RAPIDS MI
49546-6249
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-5342
  • Fax: 616-949-0071
Mailing address:
  • Phone: 616-949-5342
  • Fax: 616-949-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMJ007129
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL R. JARVIS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 616-949-5342