Individual
DR. BRIAN MITCHELL BOVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 267-0118
(616) 267-0090
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
4301100059
MI
208000000X
Pediatrics Physician
4301100059
MI
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
4301100059
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902863871
—
MI
Enumeration date
04/26/2006
Last updated
06/04/2025
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