Provider Demographics
NPI:1235143090
Name:WEST MICHIGAN NEPHROLOGY PLLC
Entity Type:Organization
Organization Name:WEST MICHIGAN NEPHROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-733-1912
Mailing Address - Street 1:1250 MERCY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1881
Mailing Address - Country:US
Mailing Address - Phone:231-733-1912
Mailing Address - Fax:231-737-4603
Practice Address - Street 1:1250 MERCY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1881
Practice Address - Country:US
Practice Address - Phone:231-733-1912
Practice Address - Fax:231-737-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F16037Medicare PIN