Individual
MR. GARRETT DAVID BAZANY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8000
Mailing address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12455935-1206
UT
363A00000X
Physician Assistant
5601010605
MI
363AM0700X
Medical Physician Assistant
5601010605
MI
Other
Enumeration date
09/29/2021
Last updated
03/11/2026
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