Provider Demographics
NPI:1649274408
Name:GIANTURCO, MICHELLE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:GIANTURCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4868 LAKE MICHIGAN DR
Practice Address - Street 2:# 2
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8434
Practice Address - Country:US
Practice Address - Phone:616-391-2800
Practice Address - Fax:616-391-7709
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4243268Medicaid
MIF40590Medicare UPIN
MIOD16321031Medicare ID - Type Unspecified