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General NPI Number Information
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NPI Number | 1245572007
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Entity Type | Organization
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Legal Business Name | PENNANT PHYSICIAN SERVICES
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 555 MIDTOWNE ST NE SUITE 310
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5729
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Country | US
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Telephone | 616-252-4765
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Fax |
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Provider Business Mailing Address
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Address Line | 2122 HEALTH DR SW SUITE 230
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City | WYOMING
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State | MI
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Zip | 49519-9698
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | FRANK E BELSITO
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Credential | DO
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Telephone | 616-252-5211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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