Individual
DR. JUSTIN BLAAUWENDRAAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 LAFAYETTE AVE SE, SUITE 4000, GRAND RAPIDS, MI 49503-4692
(616) 685-6922
Mailing address
300 LAFAYETTE AVE SE, SUITE 4000, GRAND RAPIDS, MI 49503-4692
(616) 685-6922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301107794
MI
Other
Enumeration date
06/30/2015
Last updated
06/30/2015
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