Healthcare Provider Details

I. General information

NPI: 1629737838
Provider Name (Legal Business Name): COMMUNITY LIFE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

IV. Provider business mailing address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-2370
  • Fax: 616-527-3824
Mailing address:
  • Phone: 616-527-2370
  • Fax: 616-527-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHEILA MARIE GENDICH
Title or Position: MD
Credential:
Phone: 616-527-2370