Healthcare Provider Details

I. General information

NPI: 1639496466
Provider Name (Legal Business Name): PALLIATIVE CARE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 UNION AVE NE APT 209
GRAND RAPIDS MI
49503-5747
US

IV. Provider business mailing address

430 UNION AVE NE APT 209
GRAND RAPIDS MI
49503-5747
US

V. Phone/Fax

Practice location:
  • Phone: 231-794-8011
  • Fax: 231-887-4187
Mailing address:
  • Phone: 231-794-8011
  • Fax: 231-887-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMB082824
License Number StateMI

VIII. Authorized Official

Name: DR. MALINDA BELL
Title or Position: OWNER
Credential: M.D.
Phone: 231-794-8011