Organization
WEST MICHIGAN ADDICTION CONSULTANTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE BAKER MD (PHYSICIAN)
(616) 365-8800
Entity
Organization
Contact information
Practice address
3001 FULLER AVE NE, SUITE 1, GRAND RAPIDS, MI 49505-3247
(616) 365-8800
(616) 365-7979
Mailing address
3001 FULLER AVE NE, SUITE 1, GRAND RAPIDS, MI 49505-3247
(616) 365-8800
(616) 365-7979
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
100005
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0504118411
BCBS
MI
Enumeration date
05/19/2008
Last updated
05/19/2008
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