Healthcare Provider Details

I. General information

NPI: 1659027332
Provider Name (Legal Business Name): KEVIN MICHAEL ASGAARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 WALKER AVE NE
GRAND RAPIDS MI
49544
US

IV. Provider business mailing address

4633 WOODVALLEY CT NE
ROCKFORD MI
49341-9790
US

V. Phone/Fax

Practice location:
  • Phone: 616-791-5418
  • Fax:
Mailing address:
  • Phone: 989-225-3666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302030756
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: