Individual
MR. MICHAEL E HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD, LD, CNSC
Contact information
Practice address
212 S SULLIVAN AVE, FREMONT, MI 49412-1548
(616) 391-3139
(616) 391-3044
Mailing address
100 MICHIGAN ST NE, MAIL CODE 845, GRAND RAPIDS, MI 49503-2560
(616) 486-6790
(616) 486-6702
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007732
MI
Other
Enumeration date
09/21/2012
Last updated
06/03/2016
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