Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 4301096643 | MI |
NPI | 1215075106 |
---|---|
Provider Name | Carl Wierks |
First Address | Grand Rapids, MI 49546-6117 |
Second Address | Grand Rapids, MI 49546-6117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 06/10/2021 |