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NPI Code Detail

MEDICARE: WEST MICHIGAN MEDICAL ASSOCIATES INC.

MEDICARE: WEST MICHIGAN MEDICAL ASSOCIATES INC.
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
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000053794 DOTHERMIHUMANA
2700D110750OTHERMIBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1326199498
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST MICHIGAN MEDICAL ASSOCIATES INC.
Provider Business Mailing Address
First Line : 3755 REMEMBRANCE RD NW
Second Line : STE 1
City : GRAND RAPIDS
State : MI
Zip : 49534-7745
Country : US
Telephone Number : 616-453-4403
Fax Number : 616-453-2815
Provider Business Practice Location Address
First Line : 3755 REMEMBRANCE RD NW
Second Line : STE 1
City : GRAND RAPIDS
State : MI
Zip : 49534-7745
Country : US
Telephone Number : 616-453-4403
Fax Number : 616-453-2815
Authorized Official
Title or Position : OWNER
Name : DONALD J HARDMAN
Credential : MD
Telephone Number : 616-453-4403
Provider Enumeration Date : 01/16/2007
Last Update Date : 08/19/2016

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