Healthcare Provider Details

I. General information

NPI: 1568055713
Provider Name (Legal Business Name): HBA INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CASCADE WEST PKWY SE
GRAND RAPIDS MI
49546-2164
US

IV. Provider business mailing address

500 CASCADE WEST PKWY SE
GRAND RAPIDS MI
49546-2164
US

V. Phone/Fax

Practice location:
  • Phone: 616-682-7275
  • Fax: 616-303-4212
Mailing address:
  • Phone: 616-682-7275
  • Fax: 616-303-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HAKIMA AQEL
Title or Position: MD/OWNER
Credential: MD
Phone: 616-682-7275