Individual
DOMENIC FEDERICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3800 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49534-4583
(616) 453-8225
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301034117
MI
Other
Enumeration date
05/27/2006
Last updated
02/04/2011
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