Individual
DR. MATTHEW JAMES BOUTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2680 LEONARD ST. NE, GRAND RAPIDS, MI 49525
(616) 224-1515
(616) 224-2070
Mailing address
2680 LEONARD ST NE, SUITE 2, GRAND RAPIDS, MI 49525
(616) 949-9944
(616) 949-4978
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301081178
MI
Other
Enumeration date
07/22/2005
Last updated
09/17/2018
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