Healthcare Provider Details

I. General information

NPI: 1295791630
Provider Name (Legal Business Name): FAMILY PRACTICE IN THE WOODS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WAUKAZOO DR
HOLLAND MI
49424-2556
US

IV. Provider business mailing address

PO BOX 8155
HOLLAND MI
49422-8155
US

V. Phone/Fax

Practice location:
  • Phone: 616-399-9680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301048380
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704185046
License Number StateMI

VIII. Authorized Official

Name: DR. LOWELL LAMAR STYER
Title or Position: OWNER
Credential: MD
Phone: 616-399-9680