Individual
CHARLES L DESIBOUR
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) 391-1680
Mailing address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
(616) 975-1845
(616) 285-0846
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301057841
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301057841
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930080726
RAILROAD MEDICARE
MI
Enumeration date
07/16/2006
Last updated
02/21/2025
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