Healthcare Provider Details

I. General information

NPI: 1124092275
Provider Name (Legal Business Name): EMILY ADELE GUALTIERI RILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ADELE GUALTIERI MD

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4502
US

IV. Provider business mailing address

1900 44TH ST SE
KENTWOOD MI
49508-5008
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6703
  • Fax: 616-685-3093
Mailing address:
  • Phone: 616-685-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301062241
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301062241
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301062241
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: