Individual
BALAJI VUTLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
100 MICHIGAN ST NE # A721, GRAND RAPIDS, MI 49503-2560
(616) 391-3139
(616) 391-3044
Mailing address
100 MICHIGAN ST NE, MC845, GRAND RAPIDS, MI 49503-2560
(616) 486-6790
(616) 486-6702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301100194
MI
Other
Enumeration date
06/26/2008
Last updated
08/07/2024
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