Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5101020709 | MI |
N | 111NI0900X | Internist | 5101020709 | MI |
Y | 207RC0000X | Internist - Cardiovascular Disease | 5101020709 | MI |
NPI | 1013355007 |
---|---|
Provider Name | Dr. Marcel Michael Letourneau |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Holland, MI 49423-4918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 24/02/2021 |