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General NPI Number Information
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NPI Number | 1093834772
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Entity Type | Individual
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Provider Name | DEAN GRACE DO
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 550 E WASHINGTON ST
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City | IONIA
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State | MI
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Zip | 48846-2202
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Country | US
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Telephone | 616-523-1644
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Fax |
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Provider Business Mailing Address
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Address Line | 1322 E MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912-2199
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Country | US
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Telephone | 517-364-3900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 5101011864
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License Number State | MI
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