Individual
MATTHEW VINNAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4100 LAKE DR SE, SUITE 305, GRAND RAPIDS, MI 49546-8292
(616) 267-8860
(616) 267-8442
Mailing address
247 E 8TH ST, CLIFTON, NJ 07011-1775
(970) 306-8804
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060802310
BOC
—
Enumeration date
08/31/2012
Last updated
08/31/2012
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