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Individual

KEITH B JAVERY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
710 KENMOOR AVE SE, SUITE 200, GRAND RAPIDS, MI 49546-2379
(616) 588-7246
(616) 588-7086
Mailing address
710 KENMOOR AVE SE, SUITE 200, GRAND RAPIDS, MI 49546-2379
(616) 588-7246
(616) 588-7086

Taxonomy

Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
5101012927
MI
208VP0014X
Interventional Pain Medicine Physician
Primary
5101012927
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1164664082
MI
Enumeration date
09/19/2006
Last updated
05/27/2009
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