| NPI | 1457850802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID OTTENBAKER Associate Cheif Medical Officer 616-486-6686 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2018-02-12 |