Healthcare Provider Details

I. General information

NPI: 1649193947
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF MUSKEGON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S BEACON BLVD
GRAND HAVEN MI
49417-2610
US

IV. Provider business mailing address

1400 MERCY DR STE 100
MUSKEGON MI
49444-1833
US

V. Phone/Fax

Practice location:
  • Phone: 231-733-1326
  • Fax: 231-733-5212
Mailing address:
  • Phone: 231-733-1326
  • Fax: 231-733-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LEISA KIMBROUGH
Title or Position: DIRECTOR REVENUE CYCLE
Credential: CPC
Phone: 231-830-2724