Healthcare Provider Details

I. General information

NPI: 1447260187
Provider Name (Legal Business Name): WEST MICHIGAN OB/GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

221 MICHIGAN ST NE SUITE 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 Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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