Healthcare Provider Details

I. General information

NPI: 1851324610
Provider Name (Legal Business Name): GRAND RAPIDS FERTILITY & IVF, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MID TOWNE ST NE STE 300
GRAND RAPIDS MI
49503-2515
US

IV. Provider business mailing address

555 MID TOWNE ST NE STE 300
GRAND RAPIDS MI
49503-2515
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-2030
  • Fax: 616-774-2053
Mailing address:
  • Phone: 616-774-2030
  • Fax: 616-774-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number4301057122
License Number StateMI

VIII. Authorized Official

Name: DOUGLAS CHAPMAN DALY
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 616-774-2030