Organization
GYNECOLOGIC ONCOLOGY OF WEST MICHIGAN, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI KNOX DOWNEY (PRACTICE ADMINISTRATOR)
(616) 957-3539
Entity
Organization
Contact information
Practice address
1000 E PARIS AVE SE, SUITE 242, GRAND RAPIDS, MI 49546-3691
(616) 957-3398
Mailing address
1000 E PARIS AVE SE, SUITE 242, GRAND RAPIDS, MI 49546-3691
(616) 957-3398
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P51370001
MEDICARE PTAN
—
01
—
CK3413
RAILROAD MEDICARE
—
Enumeration date
05/10/2007
Last updated
05/30/2013
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