Organization
ADDRESS HEALTHCARE OF MICHIGAN PLLC
Active
Other names
Address Healthcare of Michigan, Address Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY L WACKSMAN (AUTHORIZED OFFICIAL)
(616) 366-4234
Entity
Organization
Contact information
Practice address
600 MONROE AVENUE NW, STE 104, GRAND RAPIDS, MI 49503-1470
(616) 366-4234
(855) 548-4481
Mailing address
3940 PENINSULAR DRIVE SE, STE 230, GRAND RAPIDS, MI 49546-2442
(616) 366-4234
(855) 548-4481
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
02/16/2024
Last updated
05/05/2025
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