Provider Demographics
NPI:1275712887
Name:DR. RAFAEL TORRES PC
Entity Type:Organization
Organization Name:DR. RAFAEL TORRES PC
Other - Org Name:CASCADE IMMEDIATE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-957-8197
Mailing Address - Street 1:6460 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6918
Mailing Address - Country:US
Mailing Address - Phone:616-957-8197
Mailing Address - Fax:616-957-5095
Practice Address - Street 1:6460 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6918
Practice Address - Country:US
Practice Address - Phone:616-957-8197
Practice Address - Fax:616-957-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057250208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N96420Medicare PIN