Healthcare Provider Details

I. General information

NPI: 1639266513
Provider Name (Legal Business Name): WEST MICHIGAN OBSTETRICIANS & GYNECOLOGISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MICHIGAN ST NE STE 600
GRAND RAPIDS MI
49503-2543
US

IV. Provider business mailing address

221 MICHIGAN ST NE STE 600
GRAND RAPIDS MI
49503-2543
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-7035
  • Fax: 616-233-1456
Mailing address:
  • Phone: 616-774-7035
  • Fax: 616-233-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID A KREUZE
Title or Position: PHYSICIAN/PRESIDENT
Credential: M.D.
Phone: 616-774-7035