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General NPI Number Information
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NPI Number | 1881995330
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Entity Type | Organization
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Legal Business Name | SPECTRUM HEALTH PRIMARY CARE PARTNERS
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 1514 E MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912-2221
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Country | US
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Telephone | 616-484-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE MC 845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone | 616-486-6790
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Fax |
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Authorized Official
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Title or Position | SVP OF FINANCE
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Name | POLLY KRYWANSKI
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Credential |
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Telephone | 616-486-2253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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