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General NPI Number Information
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NPI Number | 1780883355
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Entity Type | Organization
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Legal Business Name | WEST MICHIGAN ENT PLC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1365 MERCY DR
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City | MUSKEGON
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State | MI
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Zip | 49444-1837
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Country | US
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Telephone | 231-739-9095
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Fax | 231-739-6439
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Provider Business Mailing Address
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Address Line | 1365 MERCY DR
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City | MUSKEGON
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State | MI
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Zip | 49444-1837
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Country | US
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Telephone | 231-739-9095
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Fax | 231-739-6439
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RAYMOND ROBERT KOMRAY
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Credential | M.D.
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Telephone | 231-739-9095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | MI
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