Healthcare Provider Details

I. General information

NPI: 1225007206
Provider Name (Legal Business Name): SCOTT HOWARD GREENWALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 EAST PARIS AVE SE STE 200
GRAND RAPIDS MI
49546-6113
US

IV. Provider business mailing address

5555 GLENWOOD HILLS PKWY SE STE 2
GRAND RAPIDS MI
49512-2091
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-2662
  • Fax: 616-285-1006
Mailing address:
  • Phone: 616-940-2662
  • Fax: 616-940-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301092434
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01058148A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4301092434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: