Healthcare Provider Details

I. General information

NPI: 1578509303
Provider Name (Legal Business Name): JOHN H HEALEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 64TH ST SW
BYRON CENTER MI
49315-7974
US

IV. Provider business mailing address

PO BOX 776974
CHICAGO IL
60677-6974
US

V. Phone/Fax

Practice location:
  • Phone: 616-496-5591
  • Fax: 616-465-5911
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number4301059802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: