Individual
MICHAEL FOSSEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9464 CONSERVATION ST NE, ADA, MI 49301-9752
(616) 676-8779
Mailing address
9464 CONSERVATION ST NE, ADA, MI 49301-9752
(616) 676-8779
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301046371
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1658868
—
MI
Enumeration date
09/21/2005
Last updated
05/09/2012
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