Individual
MR. MICHAEL THOMAS ROCHE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
143 BOSTWICK AVE NE, GRAND RAPIDS, MI 49503-3201
(616) 234-4260
(616) 234-4262
Mailing address
6479 LAKESHORE DR, WEST OLIVE, MI 49460-9743
(616) 638-0121
(616) 234-4260
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PROVIDER CODE 22
ATHLETIC TRAINER
MI
Enumeration date
04/07/2006
Last updated
07/08/2007
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