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Organization

SOURCE MEDICAL SOLUTIONS

Active
Other names
Source Medical Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THOMAS HENKE DO (OWNER/PHYSICIAN)
(616) 916-8063
Entity
Organization

Contact information

Practice address
625 KENMOOR AVE SE STE 301, GRAND RAPIDS, MI 49546-2395
(616) 916-8063
Mailing address
625 KENMOOR AVE SE STE 301, GRAND RAPIDS, MI 49546-2395
(616) 916-8063

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary

Other

Enumeration date
11/06/2020
Last updated
01/23/2022
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