Provider Demographics
NPI:1154572881
Name:MICHIGAN BLOOD
Entity type:Organization
Organization Name:MICHIGAN BLOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIETSCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-774-2300
Mailing Address - Street 1:PO BOX 1704
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-1704
Mailing Address - Country:US
Mailing Address - Phone:616-774-2300
Mailing Address - Fax:616-233-8612
Practice Address - Street 1:1036 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1304
Practice Address - Country:US
Practice Address - Phone:616-774-2300
Practice Address - Fax:616-233-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0724117291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory