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General NPI Number Information
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NPI Number | 1851324610
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Entity Type | Organization
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Legal Business Name | GRAND RAPIDS FERTILITY & IVF, PC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 555 MID TOWNE ST NE STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2515
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Country | US
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Telephone | 616-774-2030
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Fax | 616-774-2053
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Provider Business Mailing Address
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Address Line | 555 MID TOWNE ST NE STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2515
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Country | US
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Telephone | 616-774-2030
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Fax | 616-774-2053
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DOUGLAS CHAPMAN DALY
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Credential | MD
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Telephone | 616-774-2030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 4301057122
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License Number State | MI
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