Provider Demographics
NPI:1649206228
Name:WEST MICHIGAN INTERNAL MEDICINE PLC
Entity Type:Organization
Organization Name:WEST MICHIGAN INTERNAL MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:G SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-777-1916
Mailing Address - Street 1:1854 E APPLE AVE
Mailing Address - Street 2:A & B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3886
Mailing Address - Country:US
Mailing Address - Phone:231-777-1916
Mailing Address - Fax:231-773-8904
Practice Address - Street 1:1854 E APPLE AVE
Practice Address - Street 2:A & B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3886
Practice Address - Country:US
Practice Address - Phone:231-777-1916
Practice Address - Fax:231-773-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGR8728000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty