Provider Demographics
NPI:1366455677
Name:GIERSCH, BRIAN P (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:GIERSCH
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 1:3350 EAGLE PARK DR NE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4570
Mailing Address - Country:US
Mailing Address - Phone:616-458-1088
Mailing Address - Fax:616-458-7809
Practice Address - Street 1:3350 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 108
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4570
Practice Address - Country:US
Practice Address - Phone:616-458-1088
Practice Address - Fax:616-458-7809
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBG073347208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3505509Medicaid
MIRR250010074OtherMEDICARE RR
MIG04904Medicare UPIN
MI0D160685252Medicare ID - Type Unspecified