Healthcare Provider Details

I. General information

NPI: 1265826655
Provider Name (Legal Business Name): CRAIG N BADE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 W 8TH ST STE 220
HOLLAND MI
49423-3185
US

IV. Provider business mailing address

29 W 8TH ST STE 220
HOLLAND MI
49423-3185
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 TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704233966
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301008394
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301039774
License Number StateMI

VIII. Authorized Official

Name: MRS. KRISTI JOY HAVERDINK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 616-396-1433