Organization
JACK A DEKKINGA MD PC
Active
Other names
West Michigan Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA CHARLENE ANG MD (PRESIDENT)
(616) 257-3344
Entity
Organization
Contact information
Practice address
3434 RIVERTOWN POINT CT SW, GRANDVILLE, MI 49418-3076
(616) 257-3344
(616) 257-1491
Mailing address
3434 RIVERTOWN POINT CT SW, GRANDVILLE, MI 49418-3076
(616) 257-3344
(616) 257-1491
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301039679
MI
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070D16223
BCBS OF MICHIGAN
MI
01
—
0N86210
MEDICARE GROUP NUMBER
MI
01
—
CI2832
MEDICARE RAILROAD GROUP
NV
Enumeration date
07/20/2006
Last updated
07/31/2024
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