Healthcare Provider Details

I. General information

NPI: 1386756708
Provider Name (Legal Business Name): WESTERN MICHIGAN BONE & JOINT SURGEONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E PARIS AVE SE STE 240
GRAND RAPIDS MI
49546-6117
US

IV. Provider business mailing address

2144 E PARIS AVE SE STE 240
GRAND RAPIDS MI
49546-6117
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-8945
  • Fax: 616-949-1115
Mailing address:
  • Phone: 616-949-8945
  • Fax: 616-949-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: HEATHER DUHR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-284-3678