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General NPI Number Information
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NPI Number | 1922174218
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Entity Type | Organization
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Legal Business Name | HEALTHY FAMILY PHYSICIANS PC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2021 44TH ST SE SUITE C
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-5349
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Country | US
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Telephone | 616-827-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 44TH ST SE SUITE C
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-5349
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Country | US
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Telephone | 616-827-2020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUPERTO DIVINO BLANCO JR.
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Credential | M.D.
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Telephone | 616-827-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | MI
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