Individual
LUDWIG AXEL PHILIP TILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2925 BRETON RD SE, GRAND RAPIDS, MI 49512-1745
(616) 243-4336
Mailing address
4569 QUAIL RIDGE CT NE, ADA, MI 49301-8508
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/21/2024
Last updated
10/21/2024
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