Organization
WEST MICHIGAN FAMILY PRACTICE, PC
Active
Other names
Ada Village Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DARYL M LAWRENCE-FRIEDL D.O. (D.O.)
(616) 954-0402
Entity
Organization
Contact information
Practice address
877 FOREST HILL AVE SE, SUITE C, GRAND RAPIDS, MI 49546-2380
(616) 954-0402
(616) 954-0404
Mailing address
877 FOREST HILLS, SUITE C, GRAND RAPIDS, MI 49546-2380
(616) 954-0402
(616) 954-0404
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101010305
MI
207Q00000X
Family Medicine Physician
5101010305
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D12216
BCBS
MI
05
—
1639382211
—
MI
01
—
DH2054
RR MEDICARE
MI
Enumeration date
05/08/2007
Last updated
10/22/2011
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