Individual
MARC TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1471 E BELTLINE AVE NE, STE 201, GRAND RAPIDS, MI 49525-4548
(616) 685-8620
(616) 447-7674
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 685-1808
(616) 685-1850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301078245
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4624916
—
MI
05
—
4624925
—
MI
05
—
4628399
—
MI
05
—
4876904
—
MI
Enumeration date
05/19/2006
Last updated
12/07/2021
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