Provider Demographics
NPI:1215931258
Name:LAGRAND, PATRICIA REILLY (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:REILLY
Last Name:LAGRAND
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Gender:F
Credentials:MD
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Mailing Address - Street 1:230 MICHIGAN ST NE
Mailing Address - Street 2:STE 102
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2550
Mailing Address - Country:US
Mailing Address - Phone:616-971-0060
Mailing Address - Fax:616-301-9899
Practice Address - Street 1:230 MICHIGAN ST NE
Practice Address - Street 2:STE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2550
Practice Address - Country:US
Practice Address - Phone:616-971-0060
Practice Address - Fax:616-301-9899
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine