Organization

West Michigan Family Practice, Pc

May also be knows as Ada Village Medical

Emergency Medicine Physician in Grand Rapids, MI(View on Map)

Legal Business Name

West Michigan Family Practice, Pc

Also Known As

Ada Village Medical

NPI Number

1639382211

NPI Type

Organization

Enumeration Date

05/08/2007

Specialties

(Taxonomies)

Code

207P00000X
207Q00000X

Primary Taxonomy

Yes
No

Licenses

State

Michigan

License Number

5101010305

Contact
Information

Purpose

Mailing
Location

Address

877 FOREST HILLS
877 FOREST HILL AVE SE

City

Grand Rapids
Grand Rapids

State

MI
MI

Postal Code

49546-2380
49546-2380

Country

US
US

Telephone Number

(616) 954-0402
(616) 954-0402

Authorized Official

Name

Daryl Lawrence-friedl

Title or Position

D.O.

Telephone Number

(616) 954-0402

Identifiers

Identifier

1639382211
DH2054
0D12216

Identifier State

MI
MI
MI

Identifier Issuer

Unknown
RR MEDICARE
BCBS

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 10/22/2011

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