Healthcare Provider Details

I. General information

NPI: 1518966530
Provider Name (Legal Business Name): DALE R MEAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LAFAYETTE AVE SE 4TH FLOOR
GRAND RAPIDS MI
49503-4656
US

IV. Provider business mailing address

3565 MOMENTUM PL
CHICAGO IL
60689-5335
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-9404
  • Fax: 616-233-1108
Mailing address:
  • Phone: 616-459-9404
  • Fax: 616-233-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301043861
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: