Individual
GREGORY VANWIENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7780 20TH AVE, JENISON, MI 49428-8524
(616) 685-8700
(616) 457-5567
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 685-1808
(616) 685-1850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301063899
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3358029
—
MI
05
—
3416300
—
MI
05
—
4155666
—
MI
05
—
4876870
—
MI
Enumeration date
05/25/2006
Last updated
12/28/2021
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