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Individual

JUSTIN SHAYNE FANNING

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
221 MICHIGAN ST NE STE 300, GRAND RAPIDS, MI 49503-2537
(616) 459-7258
(616) 459-5215
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301074884
MI

Other

Enumeration date
04/04/2007
Last updated
03/14/2022
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