Provider Demographics
NPI:1639309388
Name:BIRGIOLAS, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BIRGIOLAS
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 1:431 SWARTZ CT STE 200
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-2161
Mailing Address - Country:US
Mailing Address - Phone:616-841-2615
Mailing Address - Fax:616-828-1752
Practice Address - Street 1:431 SWARTZ CT STE 200
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-2161
Practice Address - Country:US
Practice Address - Phone:616-841-2615
Practice Address - Fax:616-828-1752
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62278208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine