Healthcare Provider Details

I. General information

NPI: 1902360605
Provider Name (Legal Business Name): WILLIAM SLAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

IV. Provider business mailing address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8224
  • Fax: 616-840-9690
Mailing address:
  • Phone: 616-840-8224
  • Fax: 616-840-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008991
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: