Healthcare Provider Details

I. General information

NPI: 1932042355
Provider Name (Legal Business Name): RICHARD WALDMILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICK WALDMILLER

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 IONIA AVE NW
GRAND RAPIDS MI
49503-1020
US

IV. Provider business mailing address

3922 MAYFIELD AVE NE APT 1J
GRAND RAPIDS MI
49525-2355
US

V. Phone/Fax

Practice location:
  • Phone: 616-323-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: