Individual
ALEXANDER MERVENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 364-4200
(616) 364-7347
Mailing address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
789789817
MI
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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