# 12TH STREET PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** 12th Street Internal Medicine and Pediatrics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790470409
- **Authorized official:** JOEL VELDHOUSE MD (PHYSICIAN OWNER)
- **Authorized official phone:** (616) 648-4933

## Contact information

- **Practice address:** 3587 12TH ST, WAYLAND, MI 49348-9569
- **Practice address phone:** (616) 648-4933
- **Mailing address:** 3587 12TH ST, WAYLAND, MI 49348-9569

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 04/07/2023
- **Last updated:** 08/15/2023