=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568131555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST MICHIGAN ENDOCRINE, PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2021
-----------------------------------------------------
Last Update Date | 09/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5060 CASCADE RD SE STE C1
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-255-9521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5060 CASCADE RD SE STE C1
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-255-9521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EMILIE MENNEL COLLINS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 616-255-9521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------