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General NPI Number Information
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NPI Number | 1386633675
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Entity Type | Organization
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Legal Business Name | ALLENDALE FAMILY PRACTICE
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 11160 WJ PRESLEY PKWY STE 101
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City | ALLENDALE
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State | MI
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Zip | 49401-8075
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Country | US
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Telephone | 616-895-2000
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Fax | 616-895-2009
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Provider Business Mailing Address
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Address Line | 11160 WJ PRESLEY PKWY STE 101
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City | ALLENDALE
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State | MI
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Zip | 49401-8075
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Country | US
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Telephone | 616-895-2000
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Fax | 616-895-2009
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | BRENDA SMOCK
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Credential |
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Telephone | 616-895-2000
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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 |
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License Number State |
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