Provider Demographics
NPI:1902845936
Name:JARVIS, MICHAEL R (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:JARVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMJ007129208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0254100154OtherBCBS OF MICHIGAN
MI5410015OtherBLUE CARE NETWORK
MI308536011Medicaid
MI0D16245Medicare ID - Type UnspecifiedGROUP ID NUMBER
MIE26372Medicare UPIN