NPIMap

Organization Active NPI

MFB Professional Services Inc

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Grand Rapids, MI
National Provider Identifier
1003909524
Registry record updated Feb 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
MFB PROFESSIONAL SERVICES INC
Practice address
1155 E. Paris, Ste 200
Grand Rapids, MI 49546
Phone
(616) 233-3480
Fax
(616) 233-3481
NPI assigned
Oct 2, 2006
Last updated
Feb 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Randall L. Deneff
Title
VP Finance
Phone
(616) 242-0403

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Family Medicine Physician 207Q00000X 4301042627 MI
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 4301059802 MI
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X NU Primary

Addresses

Primary practice location

1155 E. Paris, Ste 200
Grand Rapids, MI 49546

Mailing address

235 Wealthy SE
Grand Rapids, MI 49503
Phone (616) 242-0300

National Provider Directory

National Provider Directory

Locations

1155 East Paris Ave SE
Ste 200
Grand Rapids, MI 49546
Phone (616) 233-3480

1640 East Paris Ave SE
Grand Rapids, MI 49546
Phone (616) 233-3599

245 Cherry St SE
Ste 106
Grand Rapids, MI 49503
Phone (616) 233-3595

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359936000000",
    "number": "1003909524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 WEALTHY SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-242-0300",
            "fax_number": "616-235-3997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 E. PARIS, STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-233-3480",
            "fax_number": "616-233-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MFB PROFESSIONAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2013-02-04",
        "status": "A",
        "authorized_official_last_name": "DENEFF",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "616-242-0403",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301042627",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MI",
            "license": "4301059802",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.