Individual
GARY DETWEILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
475 S STATE ST, SPARTA, MI 49345-1549
(616) 685-1300
(616) 887-5989
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 685-1808
(616) 685-1850
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002961
MI
Other
Enumeration date
05/16/2006
Last updated
06/26/2009
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