Healthcare Provider Details

I. General information

NPI: 1124400668
Provider Name (Legal Business Name): JOSE ALBERTO MORILLAS RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2015
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MICHIGAN ST NE STE 230
GRAND RAPIDS MI
49503-2550
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-2822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301504319
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: