Basic Information
| Provider Information | |||||||||
| NPI: | 1912434978 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DERBES | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3448 BROOKLYN AVE SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495082440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573093093 | ||||||||
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| Practice Location | |||||||||
| Address1: | 221 MICHIGAN ST NE STE 402 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163911405 | ||||||||
| FaxNumber: | 6163918611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301112876 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208D00000X | 4301504269 | MI | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.