Healthcare Provider Details

I. General information

NPI: 1841446499
Provider Name (Legal Business Name): GRAND RAPIDS HAND, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 GRAND RIDGE CT NE SUITE 201
GRAND RAPIDS MI
49525-7042
US

IV. Provider business mailing address

1787 GRAND RIDGE CT NE SUITE 201
GRAND RAPIDS MI
49525-7042
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-9900
  • Fax:
Mailing address:
  • Phone: 616-363-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARILEE JANE MEAD
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 616-363-9900