Individual
NILDA M OXHOLMURIBE
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
(800) 968-6866
Mailing address
PO BOX Q, GRAND RAPIDS, MI 49501-4917
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301059224
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
059224
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982699203
—
MI
05
—
3155821
—
MI
01
—
930032513
RAILROAD MEDICARE
MI
01
—
NO059224
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/13/2005
Last updated
06/11/2009
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