MEDICARE: SPECTRUM HEALTH PRIMARY CARE PARTNERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1457661597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTH PRIMARY CARE PARTNERS

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 E PARIS AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8336
Country	:	US
Telephone Number	:	616-267-7668
Fax Number	:

Authorized Official
Title or Position	:	SVP FINANCE
Name	:	LESLIE FLAKE
Credential	:
Telephone Number	:	616-486-6545

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/27/2023

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