Provider Demographics
NPI:1528487048
Name:ACKERMAN, PAUL J (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MONROE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3397
Mailing Address - Country:US
Mailing Address - Phone:616-364-5295
Mailing Address - Fax:616-364-5372
Practice Address - Street 1:3000 MONROE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3397
Practice Address - Country:US
Practice Address - Phone:616-364-5295
Practice Address - Fax:616-364-5372
Is Sole Proprietor?:No
Enumeration Date:2014-04-11
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040886207R00000X
MI4301051717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine