Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 4301060010 | MI |
N | 207PE0004X | Emergency Medical Services | 4301060010 | MI |
N | 207RH0002X | Hospice and Palliative Medicine | 4301060010 | MI |
NPI | 1215955752 |
---|---|
Provider Name | Gregory S Mervenne |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 02/04/2014 |