Healthcare Provider Details

I. General information

NPI: 1942919196
Provider Name (Legal Business Name): JOSEPH GERALD HEKKEMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 E APPLE AVE
MUSKEGON MI
49442-3466
US

IV. Provider business mailing address

376 E APPLE AVE
MUSKEGON MI
49442-3466
US

V. Phone/Fax

Practice location:
  • Phone: 231-724-1111
  • Fax: 231-724-4188
Mailing address:
  • Phone: 231-724-1111
  • Fax: 231-724-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: