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Organization
12TH STREET PLLC
Active
Organization
12TH STREET PLLC
Active
Other names
12th Street Internal Medicine and Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL VELDHOUSE MD (PHYSICIAN OWNER)
(616) 648-4933
Entity
Organization
Contact information
Practice address
3587 12TH ST, WAYLAND, MI 49348-9569
(616) 648-4933
Mailing address
3587 12TH ST, WAYLAND, MI 49348-9569
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
04/07/2023
Last updated
08/15/2023
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