Organization
MMPC WEIGHT MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL GREVENGOED (CPA)
(616) 974-4431
Entity
Organization
Contact information
Practice address
4100 LAKE DR SE, S-B01, GRAND RAPIDS, MI 49546-8292
(616) 974-4400
Mailing address
4100 LAKE DR SE, S-300, GRAND RAPIDS, MI 49546-8292
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
07/25/2006
Last updated
08/22/2020
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