Individual
LYDIA FALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
(616) 988-8220
(616) 957-3220
Mailing address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
(616) 570-2820
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011578
MI
Other
Enumeration date
01/13/2023
Last updated
01/24/2023
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