Individual
HESHAN JUDE FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
275 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2531
(616) 267-7401
(616) 267-7594
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301017923
MI
103TC0700X
Clinical Psychologist
6301017923
MI
2084N0600X
Clinical Neurophysiology Physician
6301017923
MI
Other
Enumeration date
06/19/2019
Last updated
12/09/2024
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