Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101015322 | MI |
NPI | 1184722555 |
---|---|
Provider Name | Dr. Michael Thomas Kolinski |
First Address | Grand Rapids, MI 49512-2091 |
Second Address | Portage, MI 49024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 04/05/2021 |