Individual
DAVID A LISTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3200 EAGLE PARK DR NE, STE 102, GRAND RAPIDS, MI 49525-7057
(616) 285-9090
(616) 285-7947
Mailing address
3200 EAGLE PARK DR NE, SUITE 102, GRAND RAPIDS, MI 49525-7057
(616) 285-9090
(616) 285-7947
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
4301062432
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2904154311
BCBS OF MICHIGAN
MI
05
—
3207721
—
MI
Enumeration date
08/24/2006
Last updated
06/15/2010
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