Provider Demographics
NPI:1831131226
Name:MICHAEL R. JARVIS, DO PC
Entity Type:Organization
Organization Name:MICHAEL R. JARVIS, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-949-5342
Mailing Address - Street 1:4047 SALADIN DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6249
Mailing Address - Country:US
Mailing Address - Phone:616-949-5342
Mailing Address - Fax:616-949-0071
Practice Address - Street 1:4047 SALADIN DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6249
Practice Address - Country:US
Practice Address - Phone:616-949-5342
Practice Address - Fax:616-949-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMJ007129208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherEIN NUMBER
MI0D16245Medicare UPIN