Healthcare Provider Details

I. General information

NPI: 1013118892
Provider Name (Legal Business Name): WEST SHORE OBGYN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 E APPLE AVE SUITES B & C
MUSKEGON MI
49442-3881
US

IV. Provider business mailing address

1844 E APPLE AVE SUITES B & C
MUSKEGON MI
49442-3881
US

V. Phone/Fax

Practice location:
  • Phone: 231-767-1775
  • Fax: 231-767-1776
Mailing address:
  • Phone: 231-767-1775
  • Fax: 231-767-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberDW011812
License Number StateMI

VIII. Authorized Official

Name: MS. DENISE MARIE WARREN
Title or Position: OBGYN
Credential: D.O.
Phone: 231-767-1775