Matthew James Boutell MD

NPI 1043210818 - Family Medicine - 207Q00000X

NPI Details
NPI 1043210818
Gender Male
Enumeration Date 07/22/2005
Last Updated 03/08/2011
Entity Type Individual
Active Over 12 years ago
Practice Location
5251 CLYDE PARK SW
WYOMING MI, 49509, US
Phone (616) 532-1100
Fax (616) 249-2246
Business Location
829 FOREST HILL AVE SE
GRAND RAPIDS MI, 49546-2387, US
Phone (616) 949-2410
Fax (616) 949-9948
Toxanomy
Taxonomy Code 207Q00000X
License State Michigan
License Number 4301081178
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According to our database, Dr. Matthew James Boutell MD NPI is 1043210818, taxonomy code is 207Q00000X and license number is 4301081178, license state is located at Michigan. Matthew James Boutell MD physically located at 5251 Clyde Park Sw, Wyoming MI, 49509. NPI Number Matthew James Boutell MD has the Individual type.

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1043210818 NPI number is provided on an as is basis without warranty of any kind. 1043210818 is maintained by the National Plan & Provider Enumeration System. The contents of Matthew James Boutell MD are for informational purposes only.