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NPI Code Detail

MEDICARE: DAVID BOUWKAMP PA-C

MEDICARE: DAVID BOUWKAMP PA-C
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
1363A00000XPhysician Assistant5601001907MI

General Provider Information

NPI Number : 1982689733
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID BOUWKAMP PA-C
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number : 616-486-6790
Fax Number :
Provider Business Practice Location Address
First Line : 2111 12 MILE RD NW
Second Line :
City : SPARTA
State : MI
Zip : 49345-9754
Country : US
Telephone Number : 616-391-8470
Fax Number : 616-391-8495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 02/26/2021

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Directions to “ DAVID BOUWKAMP PA-C” Practice Location

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