Provider Demographics
NPI:1346215969
Name:GRACIAS, VICENTE CALDEIRA (MD)
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:CALDEIRA
Last Name:GRACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CHERRY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4601
Mailing Address - Country:US
Mailing Address - Phone:616-454-9246
Mailing Address - Fax:616-454-6839
Practice Address - Street 1:445 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4601
Practice Address - Country:US
Practice Address - Phone:616-454-9246
Practice Address - Fax:616-454-6839
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032510207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B46809Medicare UPIN