Healthcare Provider Details

I. General information

NPI: 1841531175
Provider Name (Legal Business Name): LINDSAY MUNTICK CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5005 CASCADE RD SE
GRAND RAPIDS MI
49546-8411
US

IV. Provider business mailing address

5005 CASCADE RD SE
GRAND RAPIDS MI
49546-8411
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-0278
  • Fax:
Mailing address:
  • Phone: 616-940-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: