Healthcare Provider Details

I. General information

NPI: 1669546537
Provider Name (Legal Business Name): HOLLY ANN PERKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2894 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-6857
US

IV. Provider business mailing address

2894 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-6857
US

V. Phone/Fax

Practice location:
  • Phone: 616-285-6080
  • Fax: 616-285-5466
Mailing address:
  • Phone: 616-285-6080
  • Fax: 616-285-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301044984
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: