Provider Demographics
NPI:1518090950
Name:WARZYNSKI, MICHAEL J (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WARZYNSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 RIMROCK CT NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6700
Mailing Address - Country:US
Mailing Address - Phone:616-363-9742
Mailing Address - Fax:
Practice Address - Street 1:1345 MONROE AVE NW
Practice Address - Street 2:SUITE 121
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505
Practice Address - Country:US
Practice Address - Phone:616-391-7554
Practice Address - Fax:616-391-7558
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician