Provider Demographics
NPI:1326199498
Name:WEST MICHIGAN MEDICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:WEST MICHIGAN MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-453-4403
Mailing Address - Street 1:3755 REMEMBRANCE RD NW
Mailing Address - Street 2:STE 1
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7745
Mailing Address - Country:US
Mailing Address - Phone:616-453-4403
Mailing Address - Fax:616-453-2815
Practice Address - Street 1:3755 REMEMBRANCE RD NW
Practice Address - Street 2:STE 1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-7745
Practice Address - Country:US
Practice Address - Phone:616-453-4403
Practice Address - Fax:616-453-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000053794 DOtherHUMANA
MI700D110750OtherBLUE CROSS BLUE SHIELD
MI700D110750OtherBLUE CROSS BLUE SHIELD