Organization
WEST MICHIGAN ANESTHESIA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK DILLON (EXECUTIVE DIRECTOR)
(616) 284-3100
Entity
Organization
Contact information
Practice address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Mailing address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D11110
BCBS PIN
MI
01
—
0D11111
BCBS PIN
MI
01
—
CG5419
RAILROAD MEDICARE
MI
Enumeration date
01/04/2006
Last updated
09/05/2019
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