MEDICARE: LARRY A POEL D.O.

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
1	207Q00000X	Family Medicine Physician	5101006558	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134121270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY A POEL D.O.

Provider Business Mailing Address
First Line	:	1310 WISCONSIN AVE
Second Line	:	SUITE 101
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2472
Country	:	US
Telephone Number	:	616-844-4528
Fax Number	:	616-847-5608

Provider Business Practice Location Address
First Line	:	1310 WISCONSIN AVE
Second Line	:	SUITE 301
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2472
Country	:	US
Telephone Number	:	616-847-1860
Fax Number	:	616-844-4670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/04/2016

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Directions to “ LARRY A POEL D.O.” Practice Location

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