Organization
BALANCE IN LIFE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THADDEUS PETER SRUTWA M.D. (M.D. OWNER)
(616) 847-5154
Entity
Organization
Contact information
Practice address
17206 VAN WAGONER RD, SPRING LAKE, MI 49456-9702
(616) 847-5154
(616) 842-1949
Mailing address
17206 VAN WAGONER RD, SPRING LAKE, MI 49456-9702
(616) 847-5154
(616) 842-1949
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
4301045363
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0700125
BLUE CROSS BLUE SHIELD
MI
01
—
1902923246
NPI FOR BALANCE IN LIFE
MI
01
—
ON90970
MEDICARE GROUP
MI
Enumeration date
03/23/2007
Last updated
01/21/2008
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