Organization
NEPHROLOGY CONSULTANTS OF GRAND RAPIDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA SUE TUCK (MANAGER BILLING)
(616) 866-2539
Entity
Organization
Contact information
Practice address
4070 LAKE DR SE, SUITE 201, GRAND RAPIDS, MI 49525
(616) 774-8200
(616) 774-0304
Mailing address
PO BOX 150185, GRAND RAPIDS, MI 49515-0185
(616) 866-2539
(616) 866-3135
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
R0044045
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3371432
—
MI
Enumeration date
09/20/2007
Last updated
09/26/2008
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