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General NPI Number Information
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NPI Number | 1144554247
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Entity Type | Organization
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Legal Business Name | SOFT MEDICAL, PC
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 4455 WILSON AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-2366
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Country | US
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Telephone | 616-532-7638
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Fax | 616-249-8346
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Provider Business Mailing Address
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Address Line | 4455 WILSON AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-2366
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Country | US
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Telephone | 616-532-7638
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Fax | 616-249-8346
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COLIN CAMPBELL HERD
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Credential | MD
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Telephone | 616-532-7638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 089203
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License Number State | MI
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