Healthcare Provider Details

I. General information

NPI: 1427227156
Provider Name (Legal Business Name): JOSHUATREE INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 PARCHMENT DR SE STE 200
GRAND RAPIDS MI
49546-2382
US

IV. Provider business mailing address

825 PARCHMENT DR SE STE 200
GRAND RAPIDS MI
49546-2382
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-0000
  • Fax: 616-949-5943
Mailing address:
  • Phone: 616-949-0000
  • Fax: 616-949-5943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4301054954
License Number StateMI

VIII. Authorized Official

Name: DR. SHEILA M, VANLOWE-PRINCE
Title or Position: PHYCISIAN
Credential: M.D.
Phone: 616-949-0000