Doctor Name: | MRS. REBECCA RED LACKS |
NPI Number: | 1689013971 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 4301103209 |
Business Practice Address: | 330 Barclay Ave Ne Suite 102 Grand Rapids, MI - 495032556 |
Business Phone Number: | 6163912160 |
Business Fax Number: | |
Mailing Address: | 330 Barclay Ave Ne, Suite 102 GRAND RAPIDS |
State: | MI |
Postal Code: | 495032556 |
Phone Number: | 6163912160 |
Fax Number: | |
NPI Enumeration Date: | 06/19/2013 |
NPI Last Update Date: | 12/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207V00000X |
License Number: | 4301103209 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | |
Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |