Basic Information
Provider Information
NPI: 1740219278
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GURIZZIAN
FirstName: DARIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3264 N EVERGREEN DR NE
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495259746
CountryCode: US
TelephoneNumber: 3133637339
FaxNumber: 6163615828
Practice Location
Address1: 1 N ATKINSON DR
Address2:  
City: LUDINGTON
State: MI
PostalCode: 494311906
CountryCode: US
TelephoneNumber: 2318452255
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/30/2006
LastUpdateDate: 09/06/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XDG011448MIY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
174021927805MI MEDICAID
300E31006001MIBLUE CROSSOTHER


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