Healthcare Provider Details

I. General information

NPI: 1114947538
Provider Name (Legal Business Name): METROPOLITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 36TH ST SE
WYOMING MI
49548-2319
US

IV. Provider business mailing address

985 GEZON PKWY SW
WYOMING MI
49509-9563
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-4100
  • Fax: 616-252-4953
Mailing address:
  • Phone: 616-252-4655
  • Fax: 616-252-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY E SUSTERICH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 616-252-5203