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General NPI Number Information
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NPI Number | 1619674512
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Entity Type | Organization
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Legal Business Name | SHORELINE ORTHOPAEDIC & SPORTS MEDICINE CLINIC P L C
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 370 N 120TH AVE
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City | HOLLAND
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State | MI
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Zip | 49424-2120
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Country | US
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Telephone | 616-396-5855
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Fax | 877-592-0688
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Provider Business Mailing Address
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Address Line | 370 N 120TH AVE
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City | HOLLAND
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State | MI
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Zip | 49424-2120
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Country | US
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Telephone | 616-396-5855
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Fax | 877-592-0688
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | TRICIA SCHILDHOUSE
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Credential | MBA
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Telephone | 616-396-5855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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