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Individual

TRAVIS M PECK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
R.D

Contact information

Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1711
Mailing address
100 MICHIGAN ST NE, MC 109, GRAND RAPIDS, MI 49503-2560

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
962037
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
962037
STATE LICENSE
MI
Enumeration date
02/07/2007
Last updated
07/08/2007
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