Provider Demographics
NPI:1194132498
Name:SPORTEL, RACHEL (NP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:SPORTEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1787 GRAND RIDGE CT NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7042
Mailing Address - Country:US
Mailing Address - Phone:616-774-8131
Mailing Address - Fax:616-774-8204
Practice Address - Street 1:1787 GRAND RIDGE CT NE
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7042
Practice Address - Country:US
Practice Address - Phone:616-774-8131
Practice Address - Fax:616-774-8204
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704249079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine