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NPI Code Detail

MEDICARE: ANTHONY G FANT JR.

MEDICARE: ANTHONY G FANT JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care AttendantF530-067275990MI

General Provider Information

NPI Number : 1043176340
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY G FANT JR.
Provider Business Mailing Address
First Line : 1156 NELAND AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-1443
Country : US
Telephone Number : 616-210-6585
Fax Number :
Provider Business Practice Location Address
First Line : 4218 BURTON ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-6121
Country : US
Telephone Number : 616-726-1985
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2025
Last Update Date : 01/02/2026

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