Healthcare Provider Details

I. General information

NPI: 1225882145
Provider Name (Legal Business Name): VALENTINE IGILIMBABAZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MICHIGAN ST NE STE 8100
GRAND RAPIDS MI
49503-2531
US

IV. Provider business mailing address

275 MICHIGAN ST NE STE 8100
GRAND RAPIDS MI
49503-2531
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-0800
  • Fax: 616-267-0801
Mailing address:
  • Phone: 616-267-0800
  • Fax: 616-267-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351053248
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: