Individual
MRS. REBECCA RED LACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
330 BARCLAY AVE NE, SUITE 102, GRAND RAPIDS, MI 49503-2556
(616) 391-2160
Mailing address
330 BARCLAY AVE NE, SUITE 102, GRAND RAPIDS, MI 49503-2556
(616) 391-2160
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301103209
MI
Other
Enumeration date
06/19/2013
Last updated
12/30/2013
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