Healthcare Provider Details

I. General information

NPI: 1114588316
Provider Name (Legal Business Name): AUSTIN PETER VOYDANOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 FOREST HILL AVE SE STE B
GRAND RAPIDS MI
49546-2380
US

IV. Provider business mailing address

877 FOREST HILL AVE SE STE B
GRAND RAPIDS MI
49546-2380
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-4465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351045581
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: