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Individual

MARK SPOOLSTRA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
300 LAFAYETTE AVE SE, SUITE 4200, GRAND RAPIDS, MI 49503-4650
(616) 685-6919
(616) 685-3063
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 685-1808
(616) 685-1850

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301050964
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3415869
MI
05
3483125
MI
05
4194243
MI
05
4203852
MI
05
4878990
MI
05
4879002
MI
Enumeration date
05/25/2006
Last updated
12/17/2021
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