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General NPI Number Information
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NPI Number | 1922248772
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Entity Type | Organization
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Legal Business Name | MERCY HEALTH PARTNERS - PHYSICIAN SPECIALIST
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1675 LEAHY ST STE 324B
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City | MUSKEGON
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State | MI
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Zip | 49442-5500
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Country | US
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Telephone | 231-672-8700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776982
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City | CHICAGO
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State | IL
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Zip | 60677-6982
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Country | US
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Telephone | 800-494-5797
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MICHAEL GUSHO
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Credential |
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Telephone | 734-398-0642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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