=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023063732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN HOUSKAMP MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 03/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 WEALTHY ST SE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49503-5247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-840-8000
-----------------------------------------------------
Fax | 616-840-9642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 WEALTHY ST SE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49503-5247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-840-8000
-----------------------------------------------------
Fax | 616-840-9642
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 50901-020
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 4301060345
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------