Healthcare Provider Details

I. General information

NPI: 1497492706
Provider Name (Legal Business Name): OHANA MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 E GRAND RIVER AVE
PORTLAND MI
48875-1628
US

IV. Provider business mailing address

1218 E GRAND RIVER AVE
PORTLAND MI
48875-1628
US

V. Phone/Fax

Practice location:
  • Phone: 517-732-8877
  • Fax: 517-659-6376
Mailing address:
  • Phone: 517-732-8877
  • Fax: 517-659-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY L SANDS
Title or Position: OWNER
Credential: PA
Phone: 517-604-1095