Healthcare Provider Details

I. General information

NPI: 1578839338
Provider Name (Legal Business Name): SPECTRUM HEALTH PRIMARY CARE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S PENNSYLVANIA AVE SUITE 204
LANSING MI
48910-3495
US

IV. Provider business mailing address

35 MICHIGAN ST NE SUITE 4150
GRAND RAPIDS MI
49503-2514
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-2600
  • Fax: 616-267-2601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: POLLY KRYWANSKI
Title or Position: SVP, FINANCE
Credential:
Phone: 616-486-2253