| Advanced Medical Group | |
|
3360 Prospect St Hudsonville MI 49426-1420 | |
| (616) 669-6702 | |
| (616) 797-4025 |
| Full Name | Advanced Medical Group |
|---|---|
| Speciality | General Practice |
| Location | 3360 Prospect St, Hudsonville, Michigan |
| Authorized Official Name and Position | Benjamin Eovaldi (PROVIDER) |
| Authorized Official Contact | 6166696702 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Medical Group 3360 Prospect St Hudsonville MI 49426-1420 Ph: (616) 669-6702 | Advanced Medical Group 3360 Prospect St Hudsonville MI 49426-1420 Ph: (616) 669-6702 |
| NPI Number | 1932741907 |
|---|---|
| Provider Enumeration Date | 10/11/2019 |
| Last Update Date | 02/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932741907 | NPI | - | NPPES |
| 5315213606 | Other | MI CONTROLLED SUBSTANCE | |
| 5101019505 | Other | MI OSTEOPATHIC MEDICAL LICENSE | |
| 1902155690 | Other | NPI TYPE 1 | |
| 14554401 | Other | CAQH# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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