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Evan Gerondale, PA
Medical Physician Assistant in Grand Rapids, Michigan
NPI 1336730662

Evan Gerondale is a Medical Physician Assistant based in Grand Rapids, MI and is specialized in Medical. Evan Gerondale practices in Grand Rapids, MI and has the professional credentials of PA. The NPI Number for Evan Gerondale is 1336730662 and holds a License No. 5601010425 (Michigan).

The current practice location address for Evan Gerondale is 1740 E Paris Ave Se, Grand Rapids, MI and can be reached out via phone at 616-949-5600 and via fax at 616-949-6571.

Location: 1740 E Paris Ave Se, Grand Rapids, MI, 49546-6204
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Provider Profile Details
NPI Number
1336730662
Provider Name
Evan Gerondale
Credential
PA
Provider Entity Type
Individual
Gender
Male
Address
1740 E Paris Ave Se, Grand Rapids, MI, 49546-6204
Phone Number
616-949-5600
Fax Number
616-949-6571
Provider Enumeration Date
01/29/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
5601010425 01 MI STATE LICENSE
institution
Provider Business Practice Location Address Details
Address
1740 E Paris Ave Se
City
State
Zip
49546-6204
Phone Number
616-949-5600
Fax Number
616-949-6571
person
Provider Business Mailing Address Details
Address
1740 E Paris Ave Se
City
State
Zip
49546-6204
Phone Number
616-949-5600
Fax Number
616-949-6571
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
5601010425 (Michigan)
Definition
Definition to come...
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