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General NPI Number Information
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NPI Number | 1952577900
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH SERVICES, PLLC
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 5900 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-9606
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Country | US
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Telephone | 616-252-4642
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 580
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City | CALEDONIA
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State | MI
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Zip | 49316-0580
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Country | US
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Telephone | 616-891-2954
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | TERESA BARANOWSKI-BIRKMEIER
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Credential | D.O.
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Telephone | 616-891-2954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101011058
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License Number State | MI
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