Healthcare Provider Details

I. General information

NPI: 1194967554
Provider Name (Legal Business Name): BALANCE IN LIFE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16986 ROBBINS RD STE 180
GRAND HAVEN MI
49417-2795
US

IV. Provider business mailing address

16986 ROBBINS RD STE 180
GRAND HAVEN MI
49417-2795
US

V. Phone/Fax

Practice location:
  • Phone: 616-229-3295
  • Fax: 616-229-3295
Mailing address:
  • Phone: 616-229-3295
  • Fax: 616-229-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number4301045363
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301045363
License Number StateMI

VIII. Authorized Official

Name: THADDEUS P. SRUTWA
Title or Position: OWNER
Credential: M.D.
Phone: 616-229-3295