| West Michigan Family Medicine-kentwood, Plc | |
|
2120 43rd St Se Suite 200 Kentwood MI 49508-3772 | |
| (616) 455-4114 | |
| (616) 455-4454 |
| Full Name | West Michigan Family Medicine-kentwood, Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 2120 43rd St Se, Kentwood, Michigan |
| Authorized Official Name and Position | Wendy Johnson (OFFICE MANAGER) |
| Authorized Official Contact | 6164554114 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Michigan Family Medicine-kentwood, Plc 2120 43rd St Se Suite 200 Kentwood MI 49508-3772 Ph: (616) 455-4114 | West Michigan Family Medicine-kentwood, Plc 2120 43rd St Se Suite 200 Kentwood MI 49508-3772 Ph: (616) 455-4114 |
| NPI Number | 1285826297 |
|---|---|
| Provider Enumeration Date | 08/14/2007 |
| Last Update Date | 08/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285826297 | NPI | - | NPPES |
| 4092931 | Medicaid | MI | |
| 4092969 | Medicaid | MI | |
| 4387357 | Medicaid | MI | |
| 4092978 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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