MEDICARE: AMBULATORY UNITED

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	208600000X	Surgery Physician
2	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1104931492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY UNITED

Provider Business Mailing Address
First Line	:	PO BOX 2566
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49501-2566
Country	:	US
Telephone Number	:	231-832-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 W OAK ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-2155
Country	:	US
Telephone Number	:	616-754-2944
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRIAN BRASSER
Credential	:
Telephone Number	:	616-754-4691

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	05/24/2010

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Directions to “AMBULATORY UNITED ” Practice Location

Language	Start Address	Practice Location

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