Individual
EVAN BAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
Mailing address
970 HARRISON BLVD, LINCOLN PARK, MI 48146-4218
(313) 330-1327
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/01/2018
Last updated
08/01/2018
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