=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679795058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLEVUE MEDICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 06/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 N MAIN ST
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49021-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-763-9416
-----------------------------------------------------
Fax | 269-763-3770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 N MAIN ST
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49021-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-763-9416
-----------------------------------------------------
Fax | 269-763-3770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. WALDO E FRANKENSTEIN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 269-763-9416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | WF004074
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------