# ADDRESS HEALTHCARE OF MICHIGAN PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Address Healthcare of Michigan, Address Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043075294
- **Authorized official:** JEFFREY L WACKSMAN (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (616) 366-4234

## Contact information

- **Practice address:** 600 MONROE AVENUE NW, STE 104, GRAND RAPIDS, MI 49503-1470
- **Practice address phone:** (616) 366-4234
- **Practice address fax:** (855) 548-4481
- **Mailing address:** 3940 PENINSULAR DRIVE SE, STE 230, GRAND RAPIDS, MI 49546-2442
- **Mailing address phone:** (616) 366-4234
- **Mailing address fax:** (855) 548-4481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 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