Healthcare Provider Details

I. General information

NPI: 1184573867
Provider Name (Legal Business Name): CHRISTOPHER MIRQUE PAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRIS MIRQUE PAS

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MICHIGAN ST NE STE 200
GRAND RAPIDS MI
49503-3314
US

IV. Provider business mailing address

1 CAMPUS DR 2015 JAMES H ZUMBERGE HALL
ALLENDALE MI
49401-9403
US

V. Phone/Fax

Practice location:
  • Phone: 616-331-5700
  • Fax:
Mailing address:
  • Phone: 616-331-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: