Organization
GRAND RIVER CARDIOLOGY, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY A MILLS (EXECUTIVE DIRECTOR)
(616) 949-8554
Entity
Organization
Contact information
Practice address
1000 E PARIS AVE SE, STE 200, GRAND RAPIDS, MI 49546-3691
(616) 949-8554
(616) 949-7027
Mailing address
1000 E PARIS AVE SE, STE 200, GRAND RAPIDS, MI 49546-3691
(616) 949-8554
(616) 949-6557
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C20434
MEDICARE RRR
MI
Enumeration date
11/03/2005
Last updated
05/03/2010
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