Healthcare Provider Details

I. General information

NPI: 1851731715
Provider Name (Legal Business Name): ANDREAS A ROINIOTIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 EMBASSY DR SE SUITE 400
GRAND RAPIDS MI
49546-2416
US

IV. Provider business mailing address

4100 EMBASSY DR SE SUITE 400
GRAND RAPIDS MI
49546-2416
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-8220
  • Fax:
Mailing address:
  • Phone: 616-988-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301103626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: