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General NPI Number Information
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NPI Number | 1457657058
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Entity Type | Organization
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Legal Business Name | WEST MICHIGAN VISITING PHYSICIANS, PLLC
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 305 THOMAS ST
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City | ALLEGAN
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State | MI
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Zip | 49010-9158
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Country | US
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Telephone | 269-673-2179
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Fax | 269-673-6992
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Provider Business Mailing Address
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Address Line | 305 THOMAS ST
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City | ALLEGAN
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State | MI
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Zip | 49010-9158
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Country | US
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Telephone | 269-673-2179
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Fax | 269-673-6992
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Authorized Official
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Title or Position | BILLER
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Name | LAURIE BOURDO
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Credential |
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Telephone | 269-673-2179
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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 | 4301064273
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License Number State | MI
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