Healthcare Provider Details

I. General information

NPI: 1104931492
Provider Name (Legal Business Name): AMBULATORY UNITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 W OAK ST
GREENVILLE MI
48838-2155
US

IV. Provider business mailing address

PO BOX 2566
GRAND RAPIDS MI
49501-2566
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-2944
  • Fax:
Mailing address:
  • Phone: 231-832-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN BRASSER
Title or Position: CEO
Credential:
Phone: 616-754-4691