Individual
MARK LOUIS GOSTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2060 E PARIS AVE SE, SUITE 200, GRAND RAPIDS, MI 49546-6113
(616) 285-1377
(616) 285-1006
Mailing address
5555 GLENWOOD HILLS PKWY SE STE 2, GRAND RAPIDS, MI 49512-2091
(616) 940-2662
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
4301041353
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1070467
FIRST HEALTH
—
01
—
1492766
CIGNA
—
01
—
40982
AETNA
—
05
—
4552951-10
—
MI
05
—
4654209-10
—
MI
01
—
550410415
BLUE CROSS BLUE SHIELD
MI
01
—
7000027071
PRIORITY HEALTH
—
Enumeration date
03/30/2006
Last updated
05/04/2021
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