Individual
JOHN H EDLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1830
(616) 391-1286
Mailing address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1830
(616) 391-1286
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
025881
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2922202
—
MI
01
—
9200011669
RAILROAD MEDICARE
MI
Enumeration date
07/12/2006
Last updated
10/30/2007
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