Healthcare Provider Details

I. General information

NPI: 1619658713
Provider Name (Legal Business Name): OPTIMED HEALTHCARE PARTNERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 CASCADE RD SE STE 60
GRAND RAPIDS MI
49546-2177
US

IV. Provider business mailing address

6480 TECHNOLOGY AVE STE A
KALAMAZOO MI
49009-8126
US

V. Phone/Fax

Practice location:
  • Phone: 269-250-8000
  • Fax: 269-250-8020
Mailing address:
  • Phone: 269-250-8000
  • Fax: 269-250-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW J REEVES
Title or Position: AUTHORIZED AGENT
Credential: R.PH.
Phone: 269-250-8018