Individual
MARY BETH TUPPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7751 BYRON CENTER AVE SW, SUITE C, BYRON CENTER, MI 49315-8001
(616) 267-7668
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301043039
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4760711
—
MI
Enumeration date
12/01/2006
Last updated
07/15/2011
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