Individual
MR. MAURICE EUGENE FONGERS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
707 S GREENVILLE WEST DR, GREENVILLE, MI 48838-3514
(616) 754-3001
(616) 754-3828
Mailing address
100 MICHIGAN ST NE, MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002820
MI
Other
Enumeration date
08/27/2006
Last updated
03/15/2021
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