Organization
ADVANCED MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN EOVALDI DO (PROVIDER)
(616) 669-6702
Entity
Organization
Contact information
Practice address
3360 PROSPECT ST, HUDSONVILLE, MI 49426-1420
(616) 669-6702
(616) 797-4025
Mailing address
3360 PROSPECT ST, HUDSONVILLE, MI 49426-1420
(616) 669-6702
(616) 797-4025
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14554401
CAQH#
—
01
—
1902155690
NPI TYPE 1
—
01
—
5101019505
MI OSTEOPATHIC MEDICAL LICENSE
—
01
—
5315213606
MI CONTROLLED SUBSTANCE
—
Enumeration date
10/11/2019
Last updated
02/03/2020
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