Healthcare Provider Details

I. General information

NPI: 1649287517
Provider Name (Legal Business Name): WEST MICHIGAN FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 3 MILE RD NW
WALKER MI
49544-8251
US

IV. Provider business mailing address

1550 3 MILE RD NW
WALKER MI
49544-8251
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-3883
  • Fax: 616-785-1982
Mailing address:
  • Phone: 616-785-3883
  • Fax: 616-785-1982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. RUTHANN FORD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 616-785-3883