Healthcare Provider Details

I. General information

NPI: 1932250693
Provider Name (Legal Business Name): PEAK PERFORMANCE INTEGRATED MEDICINE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 E BELTLINE AVE NE SUITE #3
GRAND RAPIDS MI
49525-9316
US

IV. Provider business mailing address

4150 E BELTLINE AVE NE SUITE #3
GRAND RAPIDS MI
49525-9316
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-9888
  • Fax: 616-447-9886
Mailing address:
  • Phone: 616-447-9888
  • Fax: 616-447-9886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA R SMITH
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 616-447-8888