Healthcare Provider Details

I. General information

NPI: 1568632669
Provider Name (Legal Business Name): ALLERGY & ASTHMA CENTERS OF WEST MICHIGAN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49525-1075
US

IV. Provider business mailing address

5055 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49525-1075
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-8515
  • Fax:
Mailing address:
  • Phone: 616-988-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4301073903
License Number StateMI

VIII. Authorized Official

Name: VINCENT DUBRAVEC
Title or Position: PRESIDENT
Credential: MD
Phone: 616-988-8515