| NPI | 1396165601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHA BLACKMON CEO 616-776-2128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| 122300000X Dentist | |
| 152W00000X Optometrist | |
| 208000000X Pediatrics | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2023-10-10 |