# MICHIGAN NUTRIGENETICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740997212
- **Authorized official:** DR. DEAN ALAN RUBLE DO (PRESIDENT)
- **Authorized official phone:** (616) 255-5338

## Contact information

- **Practice address:** 6701 BOCA VISTA DR NE UNIT 102, ROCKFORD, MI 49341-9655
- **Practice address phone:** (616) 255-5338
- **Mailing address:** 6701 BOCA VISTA DR NE UNIT 102, ROCKFORD, MI 49341-9655
- **Mailing address phone:** (616) 255-5338

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/03/2022
- **Last updated:** 02/08/2023