Individual
CRAIG H BETHUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1471 GRACE ST SE, GRAND RAPIDS, MI 49506-1678
(616) 913-2006
(616) 913-2005
Mailing address
1471 GRACE ST SE, GRAND RAPIDS, MI 49506-1678
(616) 913-2006
(616) 913-2005
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101007159
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-5-41-3865
BCBS PIN
MI
05
—
1134183619
—
MI
Enumeration date
04/13/2006
Last updated
12/05/2017
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