Provider Demographics
NPI:1952688350
Name:DAVID G. RAFFO MD PLLC
Entity Type:Organization
Organization Name:DAVID G. RAFFO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAFFO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:616-635-6050
Mailing Address - Street 1:PO BOX 888842
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49588-8842
Mailing Address - Country:US
Mailing Address - Phone:616-635-6050
Mailing Address - Fax:616-464-3223
Practice Address - Street 1:4452 BURTON FOREST CT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8801
Practice Address - Country:US
Practice Address - Phone:616-635-6050
Practice Address - Fax:616-464-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty