| Source Medical Clinic | |
|
625 Kenmoor Ave Se Ste 301 Grand Rapids MI 49546-2395 | |
| (616) 916-8063 | |
| Not Available |
| Full Name | Source Medical Clinic |
|---|---|
| Speciality | General Practice |
| Location | 625 Kenmoor Ave Se Ste 301, Grand Rapids, Michigan |
| Authorized Official Name and Position | Thomas Henke (OWNER/PHYSICIAN) |
| Authorized Official Contact | 6169168063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Source Medical Clinic 625 Kenmoor Ave Se Ste 301 Grand Rapids MI 49546-2395 Ph: (616) 916-8063 | Source Medical Clinic 625 Kenmoor Ave Se Ste 301 Grand Rapids MI 49546-2395 Ph: (616) 916-8063 |
| NPI Number | 1326649120 |
|---|---|
| Provider Enumeration Date | 11/06/2020 |
| Last Update Date | 01/23/2022 |
| Certification Date | 01/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326649120 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
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