# GRAND RAPIDS THORACIC SURGERY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336504760
- **Authorized official:** LOURENS J. WILLEKES II M.D. (OWNER)
- **Authorized official phone:** (616) 259-7341

## Contact information

- **Practice address:** 4500 CASCADE RD SE, SUITE 210, GRAND RAPIDS, MI 49546-3665
- **Practice address phone:** (616) 259-7341
- **Practice address fax:** (616) 259-7642
- **Mailing address:** 4500 CASCADE RD SE, SUITE 210, GRAND RAPIDS, MI 49546-3665
- **Mailing address phone:** (616) 259-7341
- **Mailing address fax:** (616) 259-7642

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 4301104138 | MI | Yes |

## Other

- **Enumeration date:** 12/30/2015
- **Last updated:** 12/30/2015