=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134509532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTROENTEROLOGY ASSOCIATES OF WESTERN MICHIGAN PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2015
-----------------------------------------------------
Last Update Date | 03/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2093 HEALTH DR SW STE 201
-----------------------------------------------------
City | WYOMING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49519-9691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-328-5350
-----------------------------------------------------
Fax | 616-452-4142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2093 HEALTH DR SW STE 201
-----------------------------------------------------
City | WYOMING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49519-9691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-328-5350
-----------------------------------------------------
Fax | 616-452-4142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPLE
-----------------------------------------------------
Name | DR. ALLAN COATES
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 616-450-2765
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------