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General NPI Number Information
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NPI Number | 1740352277
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Entity Type | Individual
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Provider Name | HARRY LEE HOLWERDA M D
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 2850 KALAMAZOO AVE
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City | GRAND RAPIDS
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State | MI
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Zip | 49560
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Country | US
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Telephone | 616-224-0407
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Fax | 616-224-0707
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Provider Business Mailing Address
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Address Line | 3587 TRICKLEWOOD DR
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City | GRAND RAPIDS
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State | MI
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Zip | 49546
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Country | US
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Telephone | 616-942-0978
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Fax | 616-224-0707
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4301027130
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License Number State | MI
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