Provider Demographics
NPI:1497984975
Name:DELA CRUZ, JUAN MIGUEL AFABLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN MIGUEL
Middle Name:AFABLE
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:530 CEDAR RIDGE DR NW
Mailing Address - Street 2:APARTMENT 3A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8512
Mailing Address - Country:US
Mailing Address - Phone:616-309-4728
Mailing Address - Fax:
Practice Address - Street 1:300 LAFAYETTE AVE SE
Practice Address - Street 2:SUITE 4000
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4650
Practice Address - Country:US
Practice Address - Phone:616-685-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301095109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine