Individual
EINER S THORLUND III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
2537 MOMENTUM PL, CHICAGO, IL 60689-5325
(616) 975-1845
(616) 285-0846
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003813
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00369754
RAILROAD MEDICARE
MI
Enumeration date
05/31/2006
Last updated
11/03/2011
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