Individual
GREGORY MICHAEL MLACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L801239
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301504388
MI
2085R0202X
Diagnostic Radiology Physician
A166901
CA
Other
Enumeration date
06/30/2015
Last updated
07/15/2021
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