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Organization
ADDRESS HEALTHCARE OF MICHIGAN PLLC
Active
Organization
ADDRESS HEALTHCARE OF MICHIGAN PLLC
Active
Other names
Address Healthcare of Michigan, Address Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY L WACKSMAN (AUTHORIZED OFFICIAL)
(616) 366-4234
Entity
Organization
Contact information
Practice address
600 MONROE AVENUE NW, STE 104, GRAND RAPIDS, MI 49503-1470
(616) 366-4234
(855) 548-4481
Mailing address
3940 PENINSULAR DRIVE SE, STE 230, GRAND RAPIDS, MI 49546-2442
(616) 366-4234
(855) 548-4481
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
NULL
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
NULL
2084P0805X
Geriatric Psychiatry Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
02/16/2024
Last updated
05/05/2025
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