Individual
DR. CHRISTOPHER J MIANECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
02003830A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
5101016517
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201022450
—
IN
Enumeration date
05/08/2007
Last updated
09/01/2020
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