Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | VS006819 | MI |
NPI | 1023019890 |
---|---|
Provider Name | Dr. Val Dennis Syring |
First Address | Grand Rapids, MI 49546-9121 |
Second Address | Grand Rapids, MI 49506-4100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2113916 | (05) | MI |
B47734 | (02) | MI |