Individual
DANIEL J STALSONBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 MICHIGAN AVE.NW, SUITE A721, GRAND RAPIDS, MI 49503
(616) 974-4493
Mailing address
100 MICHIGAN ST NE, MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004692
MI
Other
Enumeration date
10/18/2006
Last updated
01/31/2011
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