Individual
DANIEL SIMON STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
669 STOCKING AVE NW, GRAND RAPIDS, MI 49504-5176
(616) 235-1480
Mailing address
12576 POINT DR, GOWEN, MI 49326-9718
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601008348
MI
Other
Enumeration date
08/29/2017
Last updated
08/29/2017
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