Organization
GRAND RAPIDS PLASTIC SURGERY PLC
Active
Other names
Centre for Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL JEAN FEWLESS (PRACTICE ADMINISTRATOR)
(616) 454-1256
Entity
Organization
Contact information
Practice address
2060 EAST PARIS AVE SE, SUITE 150, GRAND RAPIDS, MI 49546
(616) 454-1256
(616) 454-0308
Mailing address
2060 EAST PARIS AVE SE, SUITE 150, GRAND RAPIDS, MI 49546
(616) 454-1256
(616) 454-0308
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D11002
BCBS
MI
01
—
B0001
BCN
MI
Enumeration date
04/01/2008
Last updated
07/31/2013
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