Individual
JAYASEELI BASTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1840 WEALTHY ST SE, MC 426, GRAND RAPIDS, MI 49506-2921
(616) 774-5221
(616) 774-5391
Mailing address
PO BOX 1682, GRAND RAPIDS, MI 49501-1682
(616) 774-5221
(616) 774-5391
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301083851
MI
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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