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NPI Code Detail

MEDICARE: SPECTRUM HEALTH PRIMARY CARE PARTNERS

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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1043631054
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 : 616-486-6790
Fax Number :
Provider Business Practice Location Address
First Line : 922 LAWNDALE ST
Second Line :
City : LUDINGTON
State : MI
Zip : 49431-1928
Country : US
Telephone Number : 231-845-7380
Fax Number :
Authorized Official
Title or Position : SVP FINANCE
Name : PAULINE KRYWANSKI
Credential :
Telephone Number : 616-486-2253
Provider Enumeration Date : 12/17/2013
Last Update Date : 12/17/2013

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Directions to “SPECTRUM HEALTH PRIMARY CARE PARTNERS ” Practice Location

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