Individual
MACKENZIE SUE MOQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-5576
Mailing address
260 JEFFERSON AVE SE STE 305, GRAND RAPIDS, MI 49503-4597
(616) 685-4615
(616) 685-3033
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4351047970
MI
208M00000X
Hospitalist Physician
Primary
4301512778
MI
Other
Enumeration date
06/08/2021
Last updated
11/11/2024
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