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General NPI Number Information
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NPI Number | 1255548442
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Entity Type | Individual
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Provider Name | JAMES PETER HEYBOER II MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 1310 WISCONSIN ST STE 100
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2472
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Country | US
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Telephone | 616-296-1600
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Fax | 616-296-1602
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Provider Business Mailing Address
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Address Line | 1310 WISCONSIN ST
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2472
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Country | US
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Telephone | 616-296-1600
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Fax | 616-296-1602
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301509045
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301509045
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License Number State | MI
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