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General NPI Number Information
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NPI Number | 1225007206
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Entity Type | Individual
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Provider Name | SCOTT HOWARD GREENWALD MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 2060 EAST PARIS AVE SE STE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6113
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Country | US
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Telephone | 616-940-2662
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Fax | 616-285-1006
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Provider Business Mailing Address
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Address Line | 5555 GLENWOOD HILLS PKWY SE STE 2
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-2091
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Country | US
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Telephone | 616-940-2662
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Fax | 616-940-1965
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 4301092434
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 01058148A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 4301092434
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License Number State | MI
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