Healthcare Provider Details

I. General information

NPI: 1871199182
Provider Name (Legal Business Name): MIKE W DENNIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2167 RIDGECREST RD SE APT 4
GRAND RAPIDS MI
49546-4383
US

IV. Provider business mailing address

2167 RIDGECREST RD SE APT 4
GRAND RAPIDS MI
49546-4383
US

V. Phone/Fax

Practice location:
  • Phone: 616-914-2363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: