Individual
MICHAEL PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
430 W CENTRE AVE, PORTAGE, MI 49024-5304
(269) 321-6673
(269) 324-5594
Mailing address
430 W CENTRE AVE, PORTAGE, MI 49024-5304
(269) 321-6673
(269) 324-5594
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
4301063179
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4111376
—
MI
Enumeration date
06/10/2005
Last updated
04/22/2026
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