Healthcare Provider Details

I. General information

NPI: 1942334636
Provider Name (Legal Business Name): HOSPITALISTS OF WEST MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 EAGLE PARK DR NE
GRAND RAPIDS MI
49525-7007
US

IV. Provider business mailing address

PO BOX 1682
GRAND RAPIDS MI
49501-1682
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-0600
  • Fax: 616-954-1675
Mailing address:
  • Phone: 616-954-0600
  • Fax: 616-954-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KHAN JAVAN NEDD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 616-954-0600