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NPI Code Detail

MEDICARE: BORN CLINIC, PC

MEDICARE: BORN CLINIC, PC
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
1207Q00000XFamily Medicine PhysicianMI

General Provider Information

NPI Number : 1881695484
Entity Type Code : Organization
Provider Name (Legal Business Name) : BORN CLINIC, PC
Provider Business Mailing Address
First Line : 3700 52ND ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9637
Country : US
Telephone Number : 616-656-3700
Fax Number : 616-656-3701
Provider Business Practice Location Address
First Line : 3700 52ND ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9637
Country : US
Telephone Number : 616-656-3700
Fax Number : 616-656-3701
Authorized Official
Title or Position : ACCOUNTS MANAGER
Name : JULIE MERRILL
Credential :
Telephone Number : 616-656-3700
Provider Enumeration Date : 08/03/2005
Last Update Date : 07/21/2022

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Directions to “BORN CLINIC, PC ” Practice Location

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