Basic Information
| Provider Information | |||||||||
| NPI: | 1063653798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORELLI | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 COMMERCE AVE SW | ||||||||
| Address2: | 1202 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034160 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 LAFAYETTE AVE SE | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168408684 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2009 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101017995 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208100000X | 53709-021 | WI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 50855 | CO | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.