Provider Demographics
NPI:1366540064
Name:GRAND RAPIDS VEIN CLINIC P.C.
Entity type:Organization
Organization Name:GRAND RAPIDS VEIN CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAROGIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-454-8442
Mailing Address - Street 1:1720 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2018
Mailing Address - Country:US
Mailing Address - Phone:616-454-8442
Mailing Address - Fax:
Practice Address - Street 1:1720 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2018
Practice Address - Country:US
Practice Address - Phone:616-454-8442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty