Provider Demographics
NPI:1619217890
Name:VETTUKATTIL, JOSEPH JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:VETTUKATTIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:V.J.
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:10TH FLOOR, MC 248
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-267-9150
Practice Address - Fax:616-267-1408
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011021182080P0202X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology