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General NPI Number Information
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NPI Number | 1710644224
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Entity Type | Organization
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Legal Business Name | HOLY FAMILY HEALTHCARE
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 1441 S WESTNEDGE AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-1370
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Country | US
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Telephone | 269-621-0011
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Fax | 269-621-0011
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Provider Business Mailing Address
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Address Line | 2 E MAIN ST
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City | HARTFORD
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State | MI
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Zip | 49057-1120
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Country | US
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Telephone | 269-621-0011
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Fax | 269-308-3336
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONNIE D BOUCHARD
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Credential | DO
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Telephone | 269-621-0011
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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 |
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License Number State |
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