Healthcare Provider Details

I. General information

NPI: 1073981130
Provider Name (Legal Business Name): TODD HELLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 09/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 INNES ST NE
GRAND RAPIDS MI
49503-3515
US

IV. Provider business mailing address

727 INNES ST NE
GRAND RAPIDS MI
49503-3515
US

V. Phone/Fax

Practice location:
  • Phone: 616-608-7463
  • Fax:
Mailing address:
  • Phone: 616-608-7463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number4301048413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: