Provider Demographics
NPI:1700842010
Name:YOUNG, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:YOUNG
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 1:3230 EAGLE PARK DR NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4047
Mailing Address - Country:US
Mailing Address - Phone:616-988-2229
Mailing Address - Fax:616-988-2010
Practice Address - Street 1:3230 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4047
Practice Address - Country:US
Practice Address - Phone:616-988-2229
Practice Address - Fax:616-988-2010
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3053465Medicaid
MIF81591Medicare UPIN
MI04105243162Medicare ID - Type Unspecified