Healthcare Provider Details

I. General information

NPI: 1629465653
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF WEST AND NORTHERN MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CHERRY ST SE
GRAND RAPIDS MI
49503-4601
US

IV. Provider business mailing address

425 CHERRY ST SE
GRAND RAPIDS MI
49503-4601
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-7005
  • Fax: 616-774-0516
Mailing address:
  • Phone: 616-774-7005
  • Fax: 616-774-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIDGET MARY WHITE
Title or Position: VICE PRESIDENT
Credential: MA
Phone: 616-774-7005