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General NPI Number Information
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NPI Number | 1306077623
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Entity Type | Organization
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Legal Business Name | CASCADE COMPREHENSIVE MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 4551 CASCADE RD SE STE D
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8374
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Country | US
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Telephone | 616-954-2440
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Fax | 616-954-2446
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Provider Business Mailing Address
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Address Line | 4551 CASCADE RD SE STE D
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8374
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Country | US
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Telephone | 616-954-2440
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Fax | 616-954-2446
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID D SOVA
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Credential | D.O.
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Telephone | 616-954-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101009922
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License Number State | MI
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