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DR. ROLLAND DEAN MAMBOURG MD
NPI 1417294620
Family Medicine in Grand Rapids, MI

Active since January 08, 2013
200 JEFFERSON AVE SE, MEDICAL STAFF OFFICE, GRAND RAPIDS, MI 49503(616) 685-6612(616) 685-8921 Get Directions Write a Review

NPPES record last updated: January 8, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Rolland Dean Mambourg Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ROLLAND DEAN MAMBOURG MD (NPI 1417294620) is an individual family medicine provider in Grand Rapids, Michigan, licensed in Michigan (4301039783) and active in the NPI registry since January 2013.

NPPES Registry Identity

NPI1417294620
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. ROLLAND DEAN MAMBOURGCredential: MD
Location Address200 JEFFERSON AVE SE, MEDICAL STAFF OFFICEGrand Rapids, MI 49503-4502
Mailing Address200 Jefferson Ave Se, Medical Staff OfficeGrand Rapids, MI 49503-4502
Phone(616) 685-6612
Fax(616) 685-8921
Sole ProprietorYes
Enumeration DateJanuary 8, 2013
✔ NPI 1417294620 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MI · 4301039783
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
200 JEFFERSON AVE SE, Grand Rapids, MI 49503
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHARINE LIND THOMPSON PT
Physical Therapist
200 JEFFERSON AVE SE
GRAND RAPIDS, MI 49503
Kent County (616) 685-6264
ANNE MARIE TALBOT CRNA
Nurse Anesthetist, Certified Registered
200 JEFFERSON AVE SE
GRAND RAPIDS, MI 49503
Kent County (616) 685-6063
DR. ADAM MICHAEL ANDERSON MD
Emergency Medicine
200 JEFFERSON AVE SE
GRAND RAPIDS, MI 49503
Kent County (616) 685-5000
MARIA E DIMUSTO-POORTENGA MD
Pediatrics (Neonatal-Perinatal Medicine)
200 JEFFERSON AVE SE, NICU
GRAND RAPIDS, MI 49503
Kent County (616) 752-6554
THE BOUTIQUE AT MERCY HEALTH LACKS CANCER CENTER
Durable Medical Equipment & Medical Supplies
200 JEFFERSON AVE SE
GRAND RAPIDS, MI 49503
Kent County (616) 685-5030
MELISSA SUE HUDECZ MS, OTR/L
Occupational Therapist
200 JEFFERSON AVE SE
GRAND RAPIDS, MI 49503
Kent County (616) 685-6264
TIMOTHY RUSSELL LEONARD
Nurse Practitioner (Family)
200 JEFFERSON AVE SE
GRAND RAPIDS, MI 49503
Kent County (616) 465-5910
CAMRIA RENEE DEATON BSN, RN
Registered Nurse
200 JEFFERSON AVE SE
GRAND RAPIDS, MI 49503
Kent County (616) 685-5000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Rolland Mambourg's NPI number?

The NPI number for Rolland Mambourg is 1417294620. It was assigned to this individual provider in the NPPES registry on January 8, 2013.

Where is Rolland Mambourg located?

Rolland Mambourg practices at 200 Jefferson Ave SE Medical Staff Office, Grand Rapids, MI 49503. The listed phone number is (616) 685-6612.

What is Rolland Mambourg's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Rolland Mambourg was last updated on January 8, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.