Unknown Individual – Physician Assistant, NPI 1124125588
Physician Assistant
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
100 MICHIGAN ST NE
GRAND RAPIDS, MI 495032560
Phone:
Type: Mailing
418 WASHINGTON ST
LAKEVIEW, MI 488507102
Phone: (989) 352-6474
Type: Location
1900, 44th Street Southeast, Kentwood, Kent County, Michigan, 49508, United States
KENTWOOD, MI 495085008
Phone: (616) 685-1808
Type: Mailing
Spectrum Health Pennock, 1009, West Green Street, Hastings, Barry County, Michigan, 49058, United States
HASTINGS, MI 490581710
Phone: (269) 945-3451
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 49503)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MI | |
| - | MI | |
| - | MI | |
| - | MI | |
| Physician Assistant | MI | |
| - | MI | |
| - | MI | |
| - | MI | |
| Pulmonary Disease, Critical Care (Intensivists) | MI | |
| - | MI |
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