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General NPI Number Information
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NPI Number | 1730123506
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Entity Type | Organization
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Legal Business Name | GRAND HAVEN BONE & JOINT, P.C.
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1445 SHELDON RD STE. G1
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2480
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Country | US
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Telephone | 616-296-9100
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Fax | 616-296-0145
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Provider Business Mailing Address
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Address Line | 1445 SHELDON RD STE. G1
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2480
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Country | US
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Telephone | 616-296-9100
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Fax | 616-296-0145
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | REBECCA BAKKER
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Credential | R.N.
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Telephone | 616-296-9100
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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 | DB067471
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License Number State | MI
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