Healthcare Provider Details

I. General information

NPI: 1639088503
Provider Name (Legal Business Name): RICHARD ALAN GREENE JR. BFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROOK ALLAN MCCAILLTE BFA

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 PLYMOUTH AVE NE
GRAND RAPIDS MI
49505-6028
US

IV. Provider business mailing address

5592 124TH AVE
FENNVILLE MI
49408-9403
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-1120
  • Fax:
Mailing address:
  • Phone: 269-941-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: