Organization
PEDIATRIC SURGEONS OF WEST MICHIGAN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER L JAMULA (PRACTICE MANAGER)
(616) 458-1722
Entity
Organization
Contact information
Practice address
330 BARCLAY NE, SUITE 202, GRAND RAPIDS, MI 49503
(616) 458-1722
(616) 458-0061
Mailing address
330 BARCLAY NE, SUITE 202, GRAND RAPIDS, MI 49503
(616) 458-1722
(616) 458-0061
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020D176760
BLUE CROSS BLUE SHIELD
—
Enumeration date
04/11/2006
Last updated
03/08/2017
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