Healthcare Provider Details

I. General information

NPI: 1598996480
Provider Name (Legal Business Name): GRAND RAPIDS MEDICAL EDUCATION AND RESEARCH NUMBER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 08/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

5 PALMER ST NE
GRAND RAPIDS MI
49505-4625
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number4301094849
License Number StateMI

VIII. Authorized Official

Name: DR. DANA STEIEN
Title or Position: RESIDENT/ INTERN
Credential: MD
Phone: 517-449-9661