Organization
CREEKSIDE INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHAN KHAN M.D. (PRESIDENT)
(616) 954-0600
Entity
Organization
Contact information
Practice address
358 68TH ST SW, GRAND RAPIDS, MI 49548-7179
(616) 281-0463
(616) 281-0576
Mailing address
358 68TH ST SW, GRAND RAPIDS, MI 49548-7179
(616) 281-0463
(616) 281-0576
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194836833
NPI CHARLES ANDREWS, M.D.
MI
01
—
1770545139
NPI KELLY SCHROEDER, PA-C
MI
01
—
1942311600
NPI THEODOOR BEELS, M.D.
MI
Enumeration date
01/24/2007
Last updated
07/21/2022
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