| NPI | 1790470409 |
|---|---|
| Doing Business As | 12TH STREET INTERNAL MEDICINE AND PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | JOEL VELDHOUSE Physician Owner 616-648-4933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-08-15 |