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NPI Code Detail

MEDICARE: MR. GARRETT DAVID BAZANY PA-C

MEDICARE: MR. GARRETT DAVID BAZANY PA-C
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
1363A00000XPhysician Assistant12455935-1206UT
2363A00000XPhysician Assistant5601010605MI
3363AM0700XMedical Physician Assistant5601010605MI

General Provider Information

NPI Number : 1205508215
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARRETT DAVID BAZANY PA-C
Provider Business Mailing Address
First Line : 235 WEALTHY ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-5247
Country : US
Telephone Number : 616-840-8000
Fax Number :
Provider Business Practice Location Address
First Line : 235 WEALTHY ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-5247
Country : US
Telephone Number : 616-840-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2021
Last Update Date : 03/11/2026

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