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General NPI Number Information
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NPI Number | 1649206228
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Entity Type | Organization
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Legal Business Name | WEST MICHIGAN INTERNAL MEDICINE PLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 1854 E APPLE AVE A & B
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City | MUSKEGON
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State | MI
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Zip | 49442-3886
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Country | US
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Telephone | 231-777-1916
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Fax | 231-773-8904
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Provider Business Mailing Address
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Address Line | 1854 E APPLE AVE A & B
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City | MUSKEGON
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State | MI
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Zip | 49442-3886
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Country | US
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Telephone | 231-777-1916
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Fax | 231-773-8904
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Authorized Official
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Title or Position | PHYSICAN
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Name | DR. G SCOTT RENTON
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Credential | DO
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Telephone | 231-777-1916
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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 | GR8728000
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License Number State | MI
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