Provider Demographics
NPI:1619917572
Name:KARLIN E SEVENSMA DO PC
Entity Type:Organization
Organization Name:KARLIN E SEVENSMA DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARLIN
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:SEVENSMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-667-1800
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-3140
Mailing Address - Country:US
Mailing Address - Phone:616-459-0898
Mailing Address - Fax:616-459-6963
Practice Address - Street 1:1009 44TH ST SW
Practice Address - Street 2:SUITE 101
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4480
Practice Address - Country:US
Practice Address - Phone:616-828-4622
Practice Address - Fax:616-828-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD5830OtherRAILROAD MEDICARE
0P12390Medicare PIN