Provider Demographics
NPI:1164461943
Name:HORIZON MEDICAL PC
Entity Type:Organization
Organization Name:HORIZON MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:OTTENBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-846-8540
Mailing Address - Street 1:600 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2173
Mailing Address - Country:US
Mailing Address - Phone:616-846-9712
Mailing Address - Fax:616-846-9714
Practice Address - Street 1:600 PARK AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2173
Practice Address - Country:US
Practice Address - Phone:616-846-9712
Practice Address - Fax:616-846-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N01075Medicare ID - Type Unspecified
MI0M08610Medicare ID - Type Unspecified
MI0N01076Medicare ID - Type Unspecified