Individual
BRENT L. CARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Mailing address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
363A00000X
IL
363AS0400X
Surgical Physician Assistant
Primary
5601003040
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OD14869
GROUP PTAN
MI
Enumeration date
08/20/2006
Last updated
04/29/2014
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