Provider Demographics
NPI:1972507911
Name:LAGRAND, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:LAGRAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MICHIGAN ST NE
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJL064022207VG0400X, 207VX0000X
WAMD61537370207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1604108152OtherBCBS
MI11515OtherPRIORITY HEALTH
MI1604108152OtherBCBS
MIH18285Medicare UPIN