Healthcare Provider Details

I. General information

NPI: 1114141710
Provider Name (Legal Business Name): RONALD GARETT SHOOK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 WASHINGTON AVE BLDG C
HOLLAND MI
49423
US

IV. Provider business mailing address

926 WASHINGTON AVE BLDG C
HOLLAND MI
49423
US

V. Phone/Fax

Practice location:
  • Phone: 616-393-0166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101015954
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: