Individual
DR. BRIAN J GERONDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1740 E PARIS AVE SE, GRAND RAPIDS, MI 49546-6204
(616) 949-5600
(616) 949-6571
Mailing address
1740 E PARIS AVE SE, GRAND RAPIDS, MI 49546-6204
(616) 949-5600
(616) 949-6571
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
BG076576
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0704110141
BLUE SHIELD
MI
01
—
BG076576
STATE LICENSE
MI
Enumeration date
10/21/2005
Last updated
01/10/2024
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