Organization
12TH STREET PLLC
Active
Other names
12th Street Internal Medicine and Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL VELDHOUSE MD (PHYSICIAN OWNER)
(616) 648-4933
Entity
Organization
Contact information
Practice address
3587 12TH ST, WAYLAND, MI 49348-9569
(616) 648-4933
Mailing address
3587 12TH ST, WAYLAND, MI 49348-9569
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
04/07/2023
Last updated
08/15/2023
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