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General NPI Number Information
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NPI Number | 1992801138
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY INSTITUTE OF WEST MICHIGAN PC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1430 MICHIGAN ST NE SUITE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2006
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Country | US
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Telephone | 616-459-6146
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Fax | 616-459-9277
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Provider Business Mailing Address
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Address Line | 4100 EMBASSY DR SE SUITE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2416
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Country | US
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Telephone | 616-459-6146
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Fax | 616-459-9277
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Authorized Official
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Title or Position | DOCTOR
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Name | SHAUKAT ALI KHAN
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Credential | MD
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Telephone | 616-459-6146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MI
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