Individual
RUSSELL WALTON BATES JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLC
Contact information
Practice address
40 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4304
(616) 456-1443
(616) 732-6392
Mailing address
9787 US HIGHWAY 31, BERRIEN SPRINGS, MI 49103-9543
(269) 929-6278
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401011607
MI
Other
Enumeration date
09/16/2011
Last updated
09/16/2011
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