Provider Demographics
NPI:1588165039
Name:MICHIGAN PROGRESSIVE HEALTH GRAND RAPIDS
Entity type:Organization
Organization Name:MICHIGAN PROGRESSIVE HEALTH GRAND RAPIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:JUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-805-3350
Mailing Address - Street 1:847 PARCHMENT DR SE STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2377
Mailing Address - Country:US
Mailing Address - Phone:616-805-3350
Mailing Address - Fax:
Practice Address - Street 1:847 PARCHMENT DR SE STE 105
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2377
Practice Address - Country:US
Practice Address - Phone:616-805-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty