Healthcare Provider Details

I. General information

NPI: 1740345875
Provider Name (Legal Business Name): AREA WIDE OB-GYN HEALTH SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 68TH ST SE SUITE 301
GRAND RAPIDS MI
49508
US

IV. Provider business mailing address

80 68TH ST SE SUITE 301
GRAND RAPIDS MI
49508
US

V. Phone/Fax

Practice location:
  • Phone: 616-532-1410
  • Fax: 616-532-5017
Mailing address:
  • Phone: 616-532-1410
  • Fax: 616-532-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CINDY L SHUCK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 616-257-1423