Provider Demographics
NPI:1790774214
Name:EHLERT, JOHN LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LOUIS
Last Name:EHLERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11853 GARNSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8829
Mailing Address - Country:US
Mailing Address - Phone:616-399-2886
Mailing Address - Fax:616-399-2876
Practice Address - Street 1:3290 N WELLNESS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7259
Practice Address - Country:US
Practice Address - Phone:616-399-2886
Practice Address - Fax:616-399-2876
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJE040719207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB47324Medicare UPIN
MI0N55700Medicare ID - Type Unspecified