Healthcare Provider Details

I. General information

NPI: 1568681377
Provider Name (Legal Business Name): AMY ANN BISHOP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S BEACON BLVD
GRAND HAVEN MI
49417-2607
US

IV. Provider business mailing address

1027 S BEACON BLVD
GRAND HAVEN MI
49417-2607
US

V. Phone/Fax

Practice location:
  • Phone: 616-846-2015
  • Fax: 616-846-7227
Mailing address:
  • Phone: 616-846-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301088306
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: