MEDICARE: DOMENIC FEDERICO MD

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	207V00000X	Obstetrics & Gynecology Physician	4301034117	MI

General Provider Information

NPI Number	:	1699722710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMENIC FEDERICO MD

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4583
Country	:	US
Telephone Number	:	616-453-8225
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	02/04/2011

Similar Medicare Providers

1457308488 — DIANA LYNN BITNER MD
Practice Location Address:

3800 LAKE MICHIGAN DR NW
GRAND RAPIDS, MI
49534-4583

Practice Phone: 616-267-8520
Practice Fax:

1619917820 — DAVID MENAPACE MD
Practice Location Address:

3800 LAKE MICHIGAN DR NW
GRAND RAPIDS, MI
49534-4583

Practice Phone: 616-453-8225
Practice Fax:

1053351262 — JANET MITCHELL RN, WHNP
Practice Location Address:

3800 LAKE MICHIGAN DR NW
GRAND RAPIDS, MI
49534-4583

Practice Phone: 616-453-8225
Practice Fax:

1235152471 — MARLISE B VAN ZYTVELD LMSW
Practice Location Address:

3800 LAKE MICHIGAN DR NW STE 103
GRAND RAPIDS, MI
49534-4583

Practice Phone: 616-805-3660
Practice Fax: 616-805-3631

1750443511 — MICHIGAN MEDICAL, PC.
Practice Location Address:

3800 LAKE MICHIGAN DR NW , SUITE A
GRAND RAPIDS, MI
49534-4583

Practice Phone: 616-453-8225
Practice Fax:

1790847549 — MICHIGAN MEDICAL PATIENT CARE
Practice Location Address:

3800 LAKE MICHIGAN DR NW , SUITE A
GRAND RAPIDS, MI
49534-4583

Practice Phone: 616-453-8225
Practice Fax:

Directions to “ DOMENIC FEDERICO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.