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General NPI Number Information
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NPI Number | 1215931258
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Entity Type | Individual
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Provider Name | PATRICIA REILLY LAGRAND MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 230 MICHIGAN ST NE STE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2550
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Country | US
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Telephone | 616-971-0060
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Fax | 616-301-9899
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Provider Business Mailing Address
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Address Line | 230 MICHIGAN ST NE STE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2550
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Country | US
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Telephone | 616-971-0060
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Fax | 616-301-9899
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301064095
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License Number State | MI
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