Individual
BRIAN LAFATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
Mailing address
3377 E FREE SOIL RD, FREE SOIL, MI 49411-9604
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
5351017790
MI
Other
Enumeration date
05/20/2025
Last updated
05/20/2025
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