Healthcare Provider Details

I. General information

NPI: 1194783936
Provider Name (Legal Business Name): BERNARD KENT MAUPIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LEFFINGWELL AVE NE SUITE 200
GRAND RAPIDS MI
49525-6406
US

IV. Provider business mailing address

1111 LEFFINGWELL AVE NE SUITE 200
GRAND RAPIDS MI
49525-6406
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7101
  • Fax: 616-954-9871
Mailing address:
  • Phone: 616-459-7101
  • Fax: 616-957-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4301043303
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: