Provider Demographics
NPI:1215075106
Name:WIERKS, CARL (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:WIERKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2144 E PARIS AVE SE STE 240
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6117
Mailing Address - Country:US
Mailing Address - Phone:616-949-8945
Mailing Address - Fax:616-949-1115
Practice Address - Street 1:2144 E PARIS AVE SE STE 240
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6117
Practice Address - Country:US
Practice Address - Phone:616-949-8945
Practice Address - Fax:616-949-1115
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301096643207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine