=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326199498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST MICHIGAN MEDICAL ASSOCIATES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 08/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3755 REMEMBRANCE RD NW STE 1
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49534-7745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-453-4403
-----------------------------------------------------
Fax | 616-453-2815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3755 REMEMBRANCE RD NW STE 1
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49534-7745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-453-4403
-----------------------------------------------------
Fax | 616-453-2815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DONALD J HARDMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 616-453-4403
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------