Healthcare Provider Details

I. General information

NPI: 1184079204
Provider Name (Legal Business Name): MICHAEL DAVID COREY H.I.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2397 SHIRLEY DR
JACKSON MI
49202-1521
US

IV. Provider business mailing address

3145 HENRY ST SUITE #102
GRAND RAPIDS MI
49441
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-5853
  • Fax: 517-783-5863
Mailing address:
  • Phone: 231-733-2008
  • Fax: 231-733-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number3501006800
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: