Provider Demographics
NPI:1740431832
Name:GERALD VAN WIEREN, M.D., P.C.
Entity Type:Organization
Organization Name:GERALD VAN WIEREN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:VANWIEREN
Authorized Official - Suffix:
Authorized Official - Credentials:MN
Authorized Official - Phone:231-834-5676
Mailing Address - Street 1:71 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327
Mailing Address - Country:US
Mailing Address - Phone:231-834-5676
Mailing Address - Fax:231-834-7211
Practice Address - Street 1:71 S FRONT ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327
Practice Address - Country:US
Practice Address - Phone:231-834-5676
Practice Address - Fax:231-834-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty