Healthcare Provider Details

I. General information

NPI: 1467557835
Provider Name (Legal Business Name): LAURENCE EDWARD MCCAHILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 METRO WAY SW
WYOMING MI
49519-9514
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9606
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-8100
  • Fax: 616-252-8181
Mailing address:
  • Phone: 616-252-3243
  • Fax: 616-252-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0420010490
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number4301095465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: