Individual
DEREK PAUL AXIBAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
840 COOK RD, HASTINGS, MI 49058-9616
(269) 945-9520
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2019-00572
NC
207X00000X
Orthopaedic Surgery Physician
Primary
4301501710
MI
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
4301501710
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0397730007
NSC#
NC
Enumeration date
04/01/2014
Last updated
03/10/2021
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