MEDICARE: SPECTRUM HEALTH PRIMARY CARE PARTNERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1043529589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTH PRIMARY CARE PARTNERS

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 W RANDALL ST
Second Line	:
City	:	COOPERSVILLE
State	:	MI
Zip	:	49404-1369
Country	:	US
Telephone Number	:	616-974-4860
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	PAULINE KRYWANSKI
Credential	:
Telephone Number	:	616-486-2253

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	10/31/2023

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