Individual
GERALD SCOTT WITHERELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2155 E PARIS AVE SE STE 220, GRAND RAPIDS, MI 49546-6195
(616) 685-3100
(616) 685-3111
Mailing address
PO BOX 776974, CHICAGO, IL 60677-6974
(231) 672-2119
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301070459
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4218819
—
MI
05
—
4218837
—
MI
05
—
4218846
—
MI
05
—
4218855
—
MI
05
—
4218864
—
MI
05
—
4218891
—
MI
05
—
4218917
—
MI
05
—
4218935
—
MI
05
—
4591655
—
MI
05
—
4591682
—
MI
05
—
4876833
—
MI
Enumeration date
05/19/2006
Last updated
09/30/2022
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