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NPI Code Detail

MEDICARE: SPECTRUM HEALTH UNITED

MEDICARE: SPECTRUM HEALTH 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
1207R00000XInternal Medicine Physician
2207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1649689357
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECTRUM HEALTH UNITED
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 N MAIN ST
Second Line :
City : SHERIDAN
State : MI
Zip : 48884-9235
Country : US
Telephone Number : 616-754-2944
Fax Number : 616-754-2999
Authorized Official
Title or Position : VP FINANCE
Name : RYAN JOHNSON
Credential :
Telephone Number : 616-225-6310
Provider Enumeration Date : 08/06/2014
Last Update Date : 08/06/2014

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Directions to “SPECTRUM HEALTH UNITED ” Practice Location

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