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General NPI Number Information
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NPI Number | 1952019820
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Entity Type | Organization
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Legal Business Name | GOLAN INTEGRATED PHYSICAL MEDICINE
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 3097 29TH ST SE STE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-1726
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Country | US
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Telephone | 616-741-2232
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 561564
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City | DENVER
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State | CO
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Zip | 80256-1564
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Country | US
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Telephone | 616-741-2232
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID R GOLAN
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Credential | MD
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Telephone | 808-463-9726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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