NPI 1225567902 · live from the CMS NPI Registry
Zachary Hartley-Blossom, MD
Radiology, Diagnostic Radiology in Grand Rapids, MI. National Provider Identifier 1225567902, active.
NPI record
| NPI | 1225567902 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 3264 N Evergreen Dr Ne, Grand Rapids, MI 49525 |
| Practice phone | 616-363-7272 |
| Enumerated | June 7, 2017 |
| Last updated | December 18, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology | 2085R0202X | MD17244 (RI) |
| Radiology, Diagnostic Radiology | 2085R0202X | 290918 (MA) |
| Surgery | 208600000X | LP04037 (RI) |
| Radiology, Diagnostic Radiology primary | 2085R0202X | 4301508654 (MI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.