| NPI | 1033129101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-11-04 |