Healthcare Provider Details

I. General information

NPI: 1659467603
Provider Name (Legal Business Name): CRAIG NELIS BADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 WEST 8TH STREET SUITE 240
HOLLAND MI
49423
US

IV. Provider business mailing address

29 WEST 8TH STREET SUITE 240
HOLLAND MI
49423
US

V. Phone/Fax

Practice location:
  • Phone: 616-396-1433
  • Fax: 616-396-9643
Mailing address:
  • Phone: 616-396-1433
  • Fax: 616-396-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4301039774
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: