Healthcare Provider Details

I. General information

NPI: 1023019890
Provider Name (Legal Business Name): VAL DENNIS SYRING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 BOSTON ST SE G1
GRAND RAPIDS MI
49506-4100
US

IV. Provider business mailing address

7443 KENROB DR SE
GRAND RAPIDS MI
49546-9121
US

V. Phone/Fax

Practice location:
  • Phone: 616-243-9898
  • Fax: 616-243-4296
Mailing address:
  • Phone: 616-957-0456
  • Fax: 616-243-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberVS006819
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: