Organization · NPI-2

Address Healthcare Of Michigan PLLC

Internal Medicine · Grand Rapids, MI

NPI number1043075294
StatusActive
Last updated in NPPESMay 5, 2025

Details

NPI
1043075294
Entity type
Organization (NPI-2)
Legal business name
Address Healthcare Of Michigan PLLC
Organization subpart
No
Enumeration date
Feb 16, 2024
Certification date
Apr 18, 2025
Last updated
May 5, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine––Yes
152W00000X Optometrist––
207RH0002X Internal Medicine, Hospice and Palliative Medicine––
2084P0805X ––
213ES0103X Podiatrist, Foot & Ankle Surgery––
363LA2200X Nurse Practitioner, Adult Health––

Other names

  • Address Healthcare (Doing Business As)
  • Address Healthcare Of Michigan (Doing Business As)

Practice location

600 Monroe Avenue Nw
Ste 104
Grand Rapids, MI 49503-1470

Phone 616-366-4234 · Fax 855-548-4481

Mailing address

3940 Peninsular Drive Se
Ste 230
Grand Rapids, MI 49546-2442

Phone 616-366-4234 · Fax 855-548-4481

Authorized official

Jeffrey L Wacksman
Authorized Official
6163664234

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Internal Medicine providers in Grand Rapids, MI