Healthcare Provider Details

I. General information

NPI: 1972552628
Provider Name (Legal Business Name): PATRICK JOSEPH DROSTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 CASCADE RD SE
GRAND RAPIDS MI
49546-3725
US

IV. Provider business mailing address

5050 CASCADE RD SE
GRAND RAPIDS MI
49546-3725
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-0866
  • Fax: 616-956-0281
Mailing address:
  • Phone: 616-957-0866
  • Fax: 616-956-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number047600
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number4301047600
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: