Individual
SCOTT HOWARD GREENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2060 EAST PARIS AVE SE STE 200, GRAND RAPIDS, MI 49546-6113
(616) 940-2662
(616) 285-1006
Mailing address
5555 GLENWOOD HILLS PKWY SE STE 2, GRAND RAPIDS, MI 49512-2091
(616) 940-2662
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
4301092434
MI
208VP0014X
Interventional Pain Medicine Physician
01058148A
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
4301092434
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000312961
ANTHEM PROVIDER NUMBER
IN
01
—
10590379
CAQH NUMBER
IN
05
—
200459200
—
IN
01
—
9107623
PHCS PID NUMBER
IN
Enumeration date
03/14/2006
Last updated
05/10/2021
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