Healthcare Provider Details

I. General information

NPI: 1497919286
Provider Name (Legal Business Name): PEDRO JULIO MEJIA GARAGORRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 OAK AVE
MUSKEGON MI
49442-2407
US

IV. Provider business mailing address

2249 WEALTHY ST SE SUITE 202
GRAND RAPIDS MI
49506-3052
US

V. Phone/Fax

Practice location:
  • Phone: 231-727-4444
  • Fax: 231-728-4789
Mailing address:
  • Phone: 248-952-1601
  • Fax: 248-952-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301097908
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: