Individual
ZACHARY HARTLEY-BLOSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
2085R0202X
Diagnostic Radiology Physician
290918
MA
2085R0202X
Diagnostic Radiology Physician
Primary
4301508654
MI
2085R0202X
Diagnostic Radiology Physician
MD17244
RI
208600000X
Surgery Physician
LP04037
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD17244
RI MD LICENSE
RI
Enumeration date
06/07/2017
Last updated
12/18/2023
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