Healthcare Provider Details

I. General information

NPI: 1801101985
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES OF WEST MICHIGAN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 CASCADE RD SE SUITE 100
GRAND RAPIDS MI
49546-6887
US

IV. Provider business mailing address

6735 CASCADE RD SE SUITE 100
GRAND RAPIDS MI
49546-6887
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-2550
  • Fax: 616-975-2555
Mailing address:
  • Phone: 616-975-2550
  • Fax: 616-975-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMI 5101009001
License Number StateMI

VIII. Authorized Official

Name: DR. DENNIS SETH VANWORMER
Title or Position: OWNER, PRESIDENT
Credential: D.O.
Phone: 616-975-2550