Healthcare Provider Details

I. General information

NPI: 1083933717
Provider Name (Legal Business Name): BIOCORRECT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 EAST PARIS AVE SE SUITE 21
KENTWOOD MI
49512-5457
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 616-356-5030
  • Fax: 616-656-5442
Mailing address:
  • Phone: 616-356-5000
  • Fax: 616-356-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2605
License Number StateMI

VIII. Authorized Official

Name: RICHARD LEAVER
Title or Position: CEO
Credential:
Phone: 616-356-5000