Individual
DR. MON C POULOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3225 N EVERGREEN DRIVE NE, SUITE 301, GRAND RAPIDS, MI 49525
(716) 348-7834
(616) 364-6400
Mailing address
3225 N EVERGREEN DRIVE NE, SUITE 301, GRAND RAPIDS, MI 49525
(716) 348-7834
(616) 364-6400
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301099983
MI
283Q00000X
Psychiatric Hospital
—
MI
Other
Enumeration date
07/30/2009
Last updated
01/29/2014
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