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NPI Code Detail

MEDICARE: CRESTON MEDICAL CENTER, PLLC

MEDICARE: CRESTON MEDICAL CENTER, PLLC
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
1261QH0100XHealth Service Clinic/Center4301029675MI

General Provider Information

NPI Number : 1154583078
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESTON MEDICAL CENTER, PLLC
Provider Business Mailing Address
First Line : PO BOX 2564
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49501-2564
Country : US
Telephone Number : 616-776-1275
Fax Number : 616-776-3713
Provider Business Practice Location Address
First Line : 1330 PLAINFIELD AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49505-4913
Country : US
Telephone Number : 616-776-1275
Fax Number : 616-776-3713
Authorized Official
Title or Position : ADMINISTRATOR
Name : DR. MARGO MARYLAND APP
Credential : PHD
Telephone Number : 616-776-0814
Provider Enumeration Date : 07/01/2008
Last Update Date : 07/01/2008

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Directions to “CRESTON MEDICAL CENTER, PLLC ” Practice Location

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