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NPI Code Detail

MEDICARE: MICHAEL LEO ZANDSTRA

MEDICARE: MICHAEL LEO ZANDSTRA
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
11041C0700XClinical Social Worker6801107561MI

General Provider Information

NPI Number : 1457951659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL LEO ZANDSTRA
Provider Business Mailing Address
First Line : 401 HALL ST SW STE 263
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4988
Country : US
Telephone Number : 616-719-0919
Fax Number :
Provider Business Practice Location Address
First Line : 401 HALL ST SW STE 263
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4988
Country : US
Telephone Number : 616-719-0919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2020
Last Update Date : 10/27/2020

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Directions to “ MICHAEL LEO ZANDSTRA ” Practice Location

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