Individual
MIMI EMIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
230 MICHIGAN ST NE, SUITE 230, GRAND RAPIDS, MI 49503-2550
(616) 774-2822
(616) 391-8665
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
(616) 774-2822
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
4301073780
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110D148350 / 0410939
BCBSM
—
05
—
4900269
—
MI
Enumeration date
11/10/2005
Last updated
10/29/2013
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