Provider Demographics
NPI:1639309388
Name:BIRGIOLAS, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BIRGIOLAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5555 GLENWOOD HILLS PKWY SE STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2091
Mailing Address - Country:US
Mailing Address - Phone:616-940-2662
Mailing Address - Fax:616-940-2512
Practice Address - Street 1:2147 HEALTH DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-281-1600
Practice Address - Fax:616-285-1500
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2021-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI62278208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine