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General NPI Number Information
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NPI Number | 1639382211
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Entity Type | Organization
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Legal Business Name | WEST MICHIGAN FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 877 FOREST HILL AVE SE SUITE C
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2380
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Country | US
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Telephone | 616-954-0402
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Fax | 616-954-0404
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Provider Business Mailing Address
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Address Line | 877 FOREST HILLS SUITE C
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2380
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Country | US
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Telephone | 616-954-0402
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Fax | 616-954-0404
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Authorized Official
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Title or Position | D.O.
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Name | DARYL M LAWRENCE-FRIEDL
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Credential | D.O.
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Telephone | 616-954-0402
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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 | 5101010305
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101010305
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License Number State | MI
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