=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164443149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BONE AND JOINT CARE OF WEST MICHIGAN PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 08/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 WEALTHY ST SE SUITE 290
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49506-2969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-774-0440
-----------------------------------------------------
Fax | 616-774-0818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3140
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49501-3140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-774-0440
-----------------------------------------------------
Fax | 616-774-0818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | SUSAN MICHELLE DAY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 616-774-0440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------