Basic Information
| Provider Information | |||||||||
| NPI: | 1598285173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KYRIAKAKIS | ||||||||
| FirstName: | ROXANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 MICHIGAN ST NE STE 200-A | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163911405 | ||||||||
| FaxNumber: | 6163918611 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 MICHIGAN ST NE STE 200-A | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163911405 | ||||||||
| FaxNumber: | 6163918611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 4301506900 | MI | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | 4301112945 | MI | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 4301506900 | MI | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.