| NPI | 1700625761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDRIC REYELTS President / Cmo 616-320-0096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 174400000X Specialist |
| 363AM0700X Physician Assistant Medical | |
| 363LA2200X Nurse Practitioner Adult Health | |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-05-20 |