Healthcare Provider Details

I. General information

NPI: 1770961096
Provider Name (Legal Business Name): EMILY CORDES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6741 E FULTON ST STE 201
ADA MI
49301
US

IV. Provider business mailing address

6741 E FULTON ST STE 201
ADA MI
49301
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-2500
  • Fax: 616-685-2511
Mailing address:
  • Phone: 616-685-2500
  • Fax: 616-685-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101024533
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101024533
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: