Healthcare Provider Details

I. General information

NPI: 1417001892
Provider Name (Legal Business Name): GRAND RAPIDS ALLERGY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 PARCHMENT DRIVE SE SUITE 203
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

970 PARCHMENT DRIVE SE SUITE 203
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-4840
  • Fax: 616-949-3531
Mailing address:
  • Phone: 616-949-4840
  • Fax: 616-949-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: KARYN E. GELL
Title or Position: PARTNER
Credential: M.D.
Phone: 616-949-4840