Healthcare Provider Details

I. General information

NPI: 1235323072
Provider Name (Legal Business Name): ANDREW J HEAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E PARIS AVE SE STE 100
GRAND RAPIDS MI
49546-8368
US

IV. Provider business mailing address

1155 EAST PARIS AVE SE STE 100
GRAND RAPIDS MI
49546-8368
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-8088
  • Fax: 616-459-8312
Mailing address:
  • Phone: 616-459-8088
  • Fax: 616-459-8312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301083216
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: