Healthcare Provider Details

I. General information

NPI: 1477682714
Provider Name (Legal Business Name): BRUCE ALAN BYLSMA AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BRETON RD SE
GRAND RAPIDS MI
49506-4800
US

IV. Provider business mailing address

4743 E MEADOWS DR SE
GRAND RAPIDS MI
49546-6294
US

V. Phone/Fax

Practice location:
  • Phone: 616-977-0379
  • Fax: 616-977-0379
Mailing address:
  • Phone: 616-977-0379
  • Fax: 616-977-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000300
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501002046
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: