# GRAND RAPIDS ADDICTION MEDICINE SPECIALISTS PC

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

## Provider details

- **NPI number:** 1780642355
- **Authorized official:** KHAN JAVAN NEDD M.D. (PRESIDENT)
- **Authorized official phone:** (616) 954-0600

## Contact information

- **Practice address:** 4100 LAKE DR SE, SUITE 305, GRAND RAPIDS, MI 49546-8292
- **Practice address phone:** (616) 954-0600
- **Practice address fax:** (616) 954-1675
- **Mailing address:** PO BOX 1682, GRAND RAPIDS, MI 49501-1682
- **Mailing address phone:** (616) 954-0600
- **Mailing address fax:** (616) 954-1675

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 4301047295 | MI | Yes |

## Other

- **Enumeration date:** 05/03/2006
- **Last updated:** 07/31/2007