Individual
JOHN A WALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1211 LAFAYETTE AVE NE, GRAND RAPIDS, MI 49505-5092
(616) 336-8800
(616) 336-9700
Mailing address
1211 LAFAYETTE AVE NE, GRAND RAPIDS, MI 49505-5092
(616) 336-8800
(616) 336-9700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301045167
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23330
—
MI
05
—
4502600
—
MI
Enumeration date
01/05/2007
Last updated
06/14/2016
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