# ADVANCED MEDICAL GROUP

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

## Provider details

- **NPI number:** 1932741907
- **Authorized official:** DR. BENJAMIN EOVALDI DO (PROVIDER)
- **Authorized official phone:** (616) 669-6702

## Contact information

- **Practice address:** 3360 PROSPECT ST, HUDSONVILLE, MI 49426-1420
- **Practice address phone:** (616) 669-6702
- **Practice address fax:** (616) 797-4025
- **Mailing address:** 3360 PROSPECT ST, HUDSONVILLE, MI 49426-1420
- **Mailing address phone:** (616) 669-6702
- **Mailing address fax:** (616) 797-4025

## Taxonomy

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

## Other

- **Enumeration date:** 10/11/2019
- **Last updated:** 02/03/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 14554401 | CAQH\# | — |
| 01 | — | 1902155690 | NPI TYPE 1 | — |
| 01 | — | 5101019505 | MI OSTEOPATHIC MEDICAL LICENSE | — |
| 01 | — | 5315213606 | MI CONTROLLED SUBSTANCE | — |