Provider Demographics
NPI:1942414453
Name:JOHN P LAGRAND M D P C
Entity Type:Organization
Organization Name:JOHN P LAGRAND M D P C
Other - Org Name:ADVANCED OB GYN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-971-0060
Mailing Address - Street 1:230 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2550
Mailing Address - Country:US
Mailing Address - Phone:616-971-0060
Mailing Address - Fax:616-301-9899
Practice Address - Street 1:230 MICHIGAN ST NE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2550
Practice Address - Country:US
Practice Address - Phone:616-971-0060
Practice Address - Fax:616-301-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJL064022207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty