Healthcare Provider Details

I. General information

NPI: 1699767343
Provider Name (Legal Business Name): FOREST HILLS PEDIATRIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 FOREST HILL AVE SE
GRAND RAPIDS MI
49546-2325
US

IV. Provider business mailing address

877 FOREST HILL AVE SE
GRAND RAPIDS MI
49546-2325
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-4465
  • Fax: 616-949-6191
Mailing address:
  • Phone: 616-949-4465
  • Fax: 616-949-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN H WAKEFIELD
Title or Position: PRACTICE MANAGER
Credential: MD
Phone: 616-949-4465