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General NPI Number Information
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NPI Number | 1497906481
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Entity Type | Organization
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Legal Business Name | WESTSHORE DIAGNOSTICS, PC
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 1500 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1849
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Country | US
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Telephone | 231-728-5758
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26
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City | MUSKEGON
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State | MI
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Zip | 49443-0026
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Country | US
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Telephone | 231-728-5758
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Fax | 231-728-5636
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Authorized Official
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Title or Position | PRESIDENT
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Name | OCTAVIA B GRAUR
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Credential | MD
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Telephone | 231-728-5758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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