Individual
DR. BRYAN JON PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 LAFAYETTE AVE SE, 4TH FLOOR, GRAND RAPIDS, MI 49503-4656
(616) 459-9404
Mailing address
3565 MOMENTUM PL, CHICAGO, IL 60689-5335
(616) 459-9404
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036-125552
IL
207X00000X
Orthopaedic Surgery Physician
Primary
4301086174
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295944239
—
MI
Enumeration date
05/22/2007
Last updated
03/21/2014
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