Provider Demographics
NPI:1477682714
Name:BYLSMA, BRUCE ALAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:BYLSMA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4743 E MEADOWS DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6294
Mailing Address - Country:US
Mailing Address - Phone:616-977-0379
Mailing Address - Fax:616-977-0379
Practice Address - Street 1:1815 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4800
Practice Address - Country:US
Practice Address - Phone:616-977-0379
Practice Address - Fax:616-977-0379
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000300231H00000X
MI3501002046237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI640D12606OtherBLUE CROSS BLUE SHIELD
MI540D10455OtherBLUE CROSS BLUE SHIELD
MI382761821051Medicaid
MI540D10455OtherBLUE CROSS BLUE SHIELD