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General NPI Number Information
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NPI Number | 1194967554
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Entity Type | Organization
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Legal Business Name | BALANCE IN LIFE, P.C.
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 16986 ROBBINS RD STE 180
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2795
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Country | US
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Telephone | 616-229-3295
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Fax | 616-229-3295
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Provider Business Mailing Address
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Address Line | 16986 ROBBINS RD STE 180
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2795
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Country | US
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Telephone | 616-229-3295
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Fax | 616-229-3295
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Authorized Official
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Title or Position | OWNER
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Name | THADDEUS P. SRUTWA
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Credential | M.D.
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Telephone | 616-229-3295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 4301045363
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301045363
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License Number State | MI
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