Healthcare Provider Details

I. General information

NPI: 1164443149
Provider Name (Legal Business Name): BONE AND JOINT CARE OF WEST MICHIGAN PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WEALTHY ST SE SUITE 290
GRAND RAPIDS MI
49506-2969
US

IV. Provider business mailing address

PO BOX 3140
GRAND RAPIDS MI
49501-3140
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-0440
  • Fax: 616-774-0818
Mailing address:
  • Phone: 616-774-0440
  • Fax: 616-774-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MICHELLE DAY
Title or Position: PARTNER
Credential: M.D.
Phone: 616-774-0440