Healthcare Provider Details

I. General information

NPI: 1932787942
Provider Name (Legal Business Name): MICHAEL PRYOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MICHIGAN ST NE STE 400
GRAND RAPIDS MI
49503-2538
US

IV. Provider business mailing address

221 MICHIGAN ST NE STE 400
GRAND RAPIDS MI
49503-2538
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-9600
  • Fax: 616-486-9601
Mailing address:
  • Phone: 616-486-9600
  • Fax: 616-486-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301517719
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: