| Age Management Of West Michigan Pc | |
|
1959 E Paris Ave Se Grand Rapids MI 49546-6272 | |
| (616) 808-2695 | |
| Not Available |
| Full Name | Age Management Of West Michigan Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1959 E Paris Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Piyush Bhatnagar (CLINICAL MEDICAL DIRECTOR/OWNER) |
| Authorized Official Contact | 6168082695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Age Management Of West Michigan Pc 1959 E Paris Ave Se Grand Rapids MI 49546-6272 Ph: (616) 808-2695 | Age Management Of West Michigan Pc 1959 E Paris Ave Se Grand Rapids MI 49546-6272 Ph: (616) 808-2695 |
| NPI Number | 1558700625 |
|---|---|
| Provider Enumeration Date | 06/21/2013 |
| Last Update Date | 06/21/2013 |
| Medicare PECOS PAC ID | 2466686290 |
|---|---|
| Medicare Enrollment ID | O20131010001662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558700625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael W Borgeld |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073614251 PECOS PAC ID: 4082690417 Enrollment ID: I20040626000387 |
| Provider Name | Larry Rivera Lazaro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568449007 PECOS PAC ID: 9133105471 Enrollment ID: I20040628000007 |
| Provider Name | Piyush Bhatnagar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811961907 PECOS PAC ID: 7618944067 Enrollment ID: I20040914001245 |
| Provider Name | Kimberly A Gonyea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700994860 PECOS PAC ID: 5193793974 Enrollment ID: I20040920000705 |
| Provider Name | Shahnaz Ali |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922020478 PECOS PAC ID: 1153389697 Enrollment ID: I20041229000962 |
| Provider Name | Jayaseeli Bastin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437365897 PECOS PAC ID: 4981791878 Enrollment ID: I20071024000239 |
| Provider Name | Richard Hodgson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932108354 PECOS PAC ID: 4587705041 Enrollment ID: I20100105000765 |
| Provider Name | Khushpal Kaur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386994234 PECOS PAC ID: 4385896125 Enrollment ID: I20121130000439 |
| Provider Name | Andrea P Sylvester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942608005 PECOS PAC ID: 2062736036 Enrollment ID: I20150122000297 |
| Provider Name | Ingrid E Berdo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790169829 PECOS PAC ID: 6204140700 Enrollment ID: I20150728005278 |
| Provider Name | Michelle Klenk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043670060 PECOS PAC ID: 5092004309 Enrollment ID: I20160621000495 |
| Provider Name | Koren Jean Gebben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134690761 PECOS PAC ID: 6507102696 Enrollment ID: I20190110001380 |
| Provider Name | Emily Lauren Malvar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629673280 PECOS PAC ID: 8921411851 Enrollment ID: I20210113001699 |
| Provider Name | Laura Couture |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588055321 PECOS PAC ID: 7810204005 Enrollment ID: I20210712000828 |
| Provider Name | Mya Renee Franzo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356917124 PECOS PAC ID: 5092110221 Enrollment ID: I20210825002823 |
| Provider Name | Amber Marva Lindeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689347932 PECOS PAC ID: 0941606461 Enrollment ID: I20210909000752 |
| Provider Name | John Rizik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790245538 PECOS PAC ID: 0345674883 Enrollment ID: I20211015001446 |
| Provider Name | Katherine Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720676117 PECOS PAC ID: 1052705621 Enrollment ID: I20220224000477 |
| Provider Name | Kyle Martin Sproull |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417577933 PECOS PAC ID: 3476977448 Enrollment ID: I20220915000459 |
| Provider Name | Andrea Oster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174207765 PECOS PAC ID: 3274989181 Enrollment ID: I20231030001897 |
| Provider Name | Julianne A Lowery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063636116 PECOS PAC ID: 0042666869 Enrollment ID: I20231030002529 |
| Provider Name | Jessica Marie Staton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972215226 PECOS PAC ID: 2860840915 Enrollment ID: I20231129003134 |
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