Healthcare Provider Details

I. General information

NPI: 1104942085
Provider Name (Legal Business Name): EMILIE A COLLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/30/2023
Certification Date: 07/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE SE STE 2045
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

5060 CASCADE RD SE STE C-1
GRAND RAPIDS MI
49546-3808
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3098
  • Fax: 616-685-3095
Mailing address:
  • Phone: 616-255-9521
  • Fax: 616-255-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080409
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4301080409
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: