Healthcare Provider Details

I. General information

NPI: 1033101977
Provider Name (Legal Business Name): DIGESTIVE DISEASES SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EAST PARIS AVE SE STE 8
GRAND RAPIDS MI
49546-8260
US

IV. Provider business mailing address

PO BOX 3405
EVANSVILLE IN
47733-3405
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-6230
  • Fax: 616-942-6270
Mailing address:
  • Phone: 616-457-9000
  • Fax: 616-457-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: ASIF AZEEM
Title or Position: OWNER
Credential: MD
Phone: 616-942-6230