Individual
DR. MATTHEW WARREN SEVENSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2122 HEALTH DR SW, WYOMING, MI 49519-9698
(616) 252-5950
(616) 252-5956
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
5101014388
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4729758
—
MI
01
—
5101014388
STATE LICENSE
MI
01
—
MS014388
BCBSM PIN
MI
01
—
P00245050
RAILROAD MEDICARE
MI
Enumeration date
11/07/2005
Last updated
12/05/2017
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