Healthcare Provider Details

I. General information

NPI: 1770934325
Provider Name (Legal Business Name): PATIENT ONE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 28TH ST SE
GRAND RAPIDS MI
49508-1414
US

IV. Provider business mailing address

1740 28TH ST SE
GRAND RAPIDS MI
49508-1414
US

V. Phone/Fax

Practice location:
  • Phone: 616-200-8669
  • Fax: 616-552-1618
Mailing address:
  • Phone: 616-323-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOBEDA A SHEULY
Title or Position: OWNER
Credential: MD
Phone: 616-323-3999