Organization
LIFELINE INTERVENTIONAL THERAPEUTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM PAUL VANLONKHUYZEN PA-C (PARTNER/PHYSICIAN ASSISTANT)
(616) 400-5433
Entity
Organization
Contact information
Practice address
1179 E PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546-3682
(616) 400-5433
(616) 360-2034
Mailing address
1179 E PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546-3682
(616) 400-5433
(616) 360-2034
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
10/08/2024
Last updated
12/06/2024
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