Individual
DR. JOHN MICHAEL FORMOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 E PARIS AVE SE, STE 200, GRAND RAPIDS, MI 49546-3680
(616) 949-8554
Mailing address
1000 E PARIS AVE SE, STE 200, GRAND RAPIDS, MI 49546-3691
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
JF036515
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00322545
MEDICARE RRR
MI
Enumeration date
05/19/2006
Last updated
03/31/2008
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