Healthcare Provider Details

I. General information

NPI: 1689877367
Provider Name (Legal Business Name): ASSOCIATES IN OBSTETRICS GYNECOLOGY & INFERTILITY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 MICHIGAN ST NE SUITE 300
GRAND RAPIDS MI
49503-5720
US

IV. Provider business mailing address

545 MICHIGAN ST NE SUITE 300
GRAND RAPIDS MI
49503-5720
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-2400
  • Fax: 616-774-8528
Mailing address:
  • Phone: 616-774-2400
  • Fax: 616-774-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD M HEGGEN
Title or Position: PRESIDENT
Credential: MD
Phone: 616-774-2400