Provider Demographics
NPI:1851324610
Name:GRAND RAPIDS FERTILITY & IVF, PC
Entity Type:Organization
Organization Name:GRAND RAPIDS FERTILITY & IVF, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CHAPMAN
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-774-2030
Mailing Address - Street 1:555 MID TOWNE ST NE
Mailing Address - Street 2:STE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2515
Mailing Address - Country:US
Mailing Address - Phone:616-774-2030
Mailing Address - Fax:616-774-2053
Practice Address - Street 1:555 MID TOWNE ST NE
Practice Address - Street 2:STE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2515
Practice Address - Country:US
Practice Address - Phone:616-774-2030
Practice Address - Fax:616-774-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057122207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2807935Medicaid
MI106052OtherPREFERRED CHOICES
MI1604114301OtherBLUE CROSS BLUE SHIELD
MIB87113Medicare UPIN