Individual
THADDEUS P. SRUTWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16986 ROBBINS RD STE 180, GRAND HAVEN, MI 49417-2795
(616) 213-0253
(616) 296-2423
Mailing address
16986 ROBBINS RD STE 180, GRAND HAVEN, MI 49417-2795
(616) 229-3295
(616) 229-3295
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
4301045363
MI
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301045353
MI
208VP0000X
Pain Medicine Physician
4301045353
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0700125
BLUE CROSS BLUE SHEILD
MI
Enumeration date
06/02/2006
Last updated
08/05/2021
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