Individual
MARK R DEHAAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 LEFFINGWELL AVE NE, SUITE 200, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
(616) 464-6170
Mailing address
1111 LEFFINGWELL AVE NE, SUITE 200, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
(616) 464-6170
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
4301044330
MI
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
4301044330
MI
208600000X
Surgery Physician
4301044330
MI
2086S0105X
Surgery of the Hand (Surgery) Physician
Primary
4301044330
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4096420
—
MI
Enumeration date
08/17/2005
Last updated
07/01/2016
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