Healthcare Provider Details

I. General information

NPI: 1427052455
Provider Name (Legal Business Name): MARY JOY GOOTJES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 MICHIGAN AVE
HOLLAND MI
49423-4944
US

IV. Provider business mailing address

664 MICHIGAN AVE
HOLLAND MI
49423-4944
US

V. Phone/Fax

Practice location:
  • Phone: 616-392-5973
  • Fax: 616-392-1646
Mailing address:
  • Phone: 616-392-5973
  • Fax: 616-392-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMG070496
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMG070496
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: