Basic Information
Provider Information
NPI: 1003298555
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MYERS
FirstName: COURTNEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 LAFAYETTE AVE SE # 3000
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495034692
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 300 LAFAYETTE AVE SE # 3000
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495034692
CountryCode: US
TelephoneNumber: 6166856919
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2015
LastUpdateDate: 06/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X4301107550MIY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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