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General NPI Number Information
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NPI Number | 1396778890
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Entity Type | Organization
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Legal Business Name | GRAND VALLEY GYNECOLOGISTS, P.C.
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1900 WEALTHY ST SE SUITE 330
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-2969
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Country | US
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Telephone | 616-774-0700
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Fax | 616-774-0651
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Provider Business Mailing Address
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Address Line | 1900 WEALTHY ST SE SUITE 330
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-2969
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Country | US
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Telephone | 616-774-0700
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Fax | 616-774-0651
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS M VAN DRIE
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Credential | M.D.
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Telephone | 616-774-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | MI
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