Healthcare Provider Details

I. General information

NPI: 1689315673
Provider Name (Legal Business Name): SPENCER ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4288 3 MILE RD NW STE 1
GRAND RAPIDS MI
49534-7596
US

IV. Provider business mailing address

4288 3 MILE RD NW STE 1
GRAND RAPIDS MI
49534-7596
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-3677
  • Fax:
Mailing address:
  • Phone: 616-458-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301514077
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: