Organization
EXALTA HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM PAXTON (PRESIDENT)
(616) 475-1363
Entity
Organization
Contact information
Practice address
2060 DIVISION AVE S, GRAND RAPIDS, MI 49507-3029
(616) 475-8446
Mailing address
15 ANDRE ST SE, GRAND RAPIDS, MI 49507-3010
(616) 475-8420
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LV012688
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4355710
—
MI
Enumeration date
01/16/2008
Last updated
12/13/2017
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