Individual
JAN L MOURELATOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301052862
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H26188
BCBS PROVIDER NUMBER
MI
01
—
0Q26008
BCBS PROVIDER NUMBER
MI
01
—
0Q26008040
FED BLACK LUNG PROGRAM
—
01
—
1006439
MCLAREN HEALTH
MI
01
—
111785
GREAT LAKES HEALTH
MI
05
—
3513322
—
MI
01
—
351332210
PROCARE
MI
01
—
OH26188036
FED BLACK LUNG PROGRAM
—
01
—
P00222749
RR MEDICARE/PALMETTO GBA
—
Enumeration date
01/16/2006
Last updated
01/09/2024
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