Healthcare Provider Details

I. General information

NPI: 1720548076
Provider Name (Legal Business Name): ALEXANDER WILLIAM POWER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BRETON RD SE STE 208
GRAND RAPIDS MI
49508-5220
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-0020
  • Fax: 616-267-0021
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301507915
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: