Healthcare Provider Details

I. General information

NPI: 1306016977
Provider Name (Legal Business Name): SCOTT JAMES WESTHOUSE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CASCADE RD SE
GRAND RAPIDS MI
49546-3725
US

IV. Provider business mailing address

5030 CASCADE RD SE
GRAND RAPIDS MI
49546-3725
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-2020
  • Fax: 616-949-0408
Mailing address:
  • Phone: 616-954-2020
  • Fax: 616-949-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5101018550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: