Healthcare Provider Details

I. General information

NPI: 1639309388
Provider Name (Legal Business Name): JOHN BIRGIOLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 SWARTZ CT STE 200
IONIA MI
48846-2161
US

IV. Provider business mailing address

431 SWARTZ CT STE 200
IONIA MI
48846-2161
US

V. Phone/Fax

Practice location:
  • Phone: 616-841-2615
  • Fax: 616-828-1752
Mailing address:
  • Phone: 616-841-2615
  • Fax: 616-828-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301104365
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301104365
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4301104365
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: