MEDICARE: RENAL AND HYPERTENSION SPECIALISTS, 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
1	207RN0300X	Nephrology Physician	4301068403	MI

General Provider Information

NPI Number	:	1174898522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAL AND HYPERTENSION SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	4860 E MEADOWS CT SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4024 PARK EAST CT SE
Second Line	:	SUITE C
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8810
Country	:	US
Telephone Number	:	616-516-2192
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW J KRUTUL
Credential	:
Telephone Number	:	616-516-2192

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/19/2012

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