Healthcare Provider Details

I. General information

NPI: 1205059755
Provider Name (Legal Business Name): DONZA WORDEN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33896 S TOWNLINE RD
DRUMMOND ISLAND MI
49726
US

IV. Provider business mailing address

PO BOX 2388
GRAND RAPIDS MI
49501-2388
US

V. Phone/Fax

Practice location:
  • Phone: 800-968-6866
  • Fax:
Mailing address:
  • Phone: 800-968-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DONZA WORDEN
Title or Position: OWNER
Credential: MD
Phone: 800-968-6866