Provider Demographics
NPI:1275746455
Name:BRACAMONTES-WOOLLEY, ERIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:
Last Name:BRACAMONTES-WOOLLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 W DE BLAAY CT SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9500
Mailing Address - Country:US
Mailing Address - Phone:616-308-6954
Mailing Address - Fax:
Practice Address - Street 1:120 MICHIGAN AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-391-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine