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Individual

ERIC KARL GUSTAFSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
382 N 120TH AVE, HOLLAND, MI 49424
(616) 396-6516
(616) 396-2513
Mailing address
382 N 120TH AVE, HOLLAND, MI 49424
(616) 396-6516
(616) 396-2513

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301058257
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0700109
BCBS
MI
05
3069358
MI
01
O10052591
RAILROAD MEDICARE
MI
Enumeration date
10/02/2006
Last updated
12/14/2009
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