# SOURCE MEDICAL SOLUTIONS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Source Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326649120
- **Authorized official:** DR. THOMAS HENKE DO (OWNER/PHYSICIAN)
- **Authorized official phone:** (616) 916-8063

## Contact information

- **Practice address:** 625 KENMOOR AVE SE STE 301, GRAND RAPIDS, MI 49546-2395
- **Practice address phone:** (616) 916-8063
- **Mailing address:** 625 KENMOOR AVE SE STE 301, GRAND RAPIDS, MI 49546-2395
- **Mailing address phone:** (616) 916-8063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/06/2020
- **Last updated:** 01/23/2022