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General NPI Number Information
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NPI Number | 1679701601
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Entity Type | Organization
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Legal Business Name | GRAND RAPIDS MEDICAL EDUCATION AND RESEARCH CENTER
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 330 BARCLAY AVE NE SUITE 304
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2556
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Country | US
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Telephone | 616-391-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 330 BARCLAY AVE NE SUITE 304
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2556
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RESIDENT
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Name | DR. PETER ENGELMAN
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Credential | D.O.
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Telephone | 816-392-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 5101018314
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License Number State | MI
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