Healthcare Provider Details

I. General information

NPI: 1821874264
Provider Name (Legal Business Name): AARON SCHMUDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5557 28TH ST SE STE D
GRAND RAPIDS MI
49512-2035
US

IV. Provider business mailing address

7668 HARMONY CV SE
BYRON CENTER MI
49315-8272
US

V. Phone/Fax

Practice location:
  • Phone: 616-208-9880
  • Fax:
Mailing address:
  • Phone: 216-470-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501009649
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: