Provider Demographics
NPI:1134121270
Name:POEL, LARRY A (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:POEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 WISCONSIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2472
Mailing Address - Country:US
Mailing Address - Phone:616-844-4528
Mailing Address - Fax:616-847-5608
Practice Address - Street 1:1310 WISCONSIN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2472
Practice Address - Country:US
Practice Address - Phone:616-847-1860
Practice Address - Fax:616-844-4670
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3192057Medicaid
MA3108017Medicaid
MA3108017Medicaid
MA3108017Medicaid