Individual
DR. ROGER W. EDVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 MIDTOWNE STREET NE, SUITE 400, GRAND RAPIDS, MI 49503-5731
(616) 588-1200
(616) 588-1250
Mailing address
555 MIDTOWNE STREET NE, SUITE 400, GRAND RAPIDS, MI 49503-5731
(616) 588-1200
(616) 588-1250
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301047210
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1627084
—
MI
Enumeration date
07/18/2006
Last updated
06/07/2011
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