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Organization
WEST MICHIGAN FAMILY MEDICINE-KENTWOOD, PLC
Active
Organization
WEST MICHIGAN FAMILY MEDICINE-KENTWOOD, PLC
Active
Parent organization
WEST MICHIGAN FAMILY MEDICINE, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST MICHIGAN FAMILY MEDICINE, PC
Authorized official
WENDY JOHNSON (OFFICE MANAGER)
(616) 455-4114
Entity
Organization
Contact information
Practice address
2120 43RD ST SE, SUITE 200, KENTWOOD, MI 49508-3772
(616) 455-4114
(616) 455-4454
Mailing address
2120 43RD ST SE, SUITE 200, KENTWOOD, MI 49508-3772
(616) 455-4114
(616) 455-4454
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4092931
—
MI
05
—
4092969
—
MI
05
—
4092978
—
MI
05
—
4387357
—
MI
Enumeration date
08/14/2007
Last updated
08/14/2007
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