Organization
GERIATRIC & EXTENDED REHABILITATION MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD EZRA RUTHERFORD D.O. (OWNER PRESIDENT)
(616) 844-4067
Entity
Organization
Contact information
Practice address
1159 S HARBOR DR, SUITE C-4, GRAND HAVEN, MI 49417-1777
(616) 844-4067
(616) 844-4067
Mailing address
1159 S HARBOR, C4, GRAND HAVEN, MI 49417-1777
(616) 844-4067
(616) 844-4067
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
5101009705
MI
Other
Enumeration date
06/16/2006
Last updated
10/04/2011
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