Healthcare Provider Details

I. General information

NPI: 1922580604
Provider Name (Legal Business Name): GEOFFREY BELLHORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ROCKWELL DR
MIDLAND MI
48642-9316
US

IV. Provider business mailing address

3483 HIGHLAND DR
BAY CITY MI
48706-2414
US

V. Phone/Fax

Practice location:
  • Phone: 989-633-5350
  • Fax:
Mailing address:
  • Phone: 989-252-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704310088
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: