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Individual

FOLABO Y DARE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH STREET SE, GRAND RAPIDS, MI 49548
(616) 455-5000

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
56516
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1750644548
MI
Enumeration date
06/18/2012
Last updated
11/17/2022
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