Provider Demographics
NPI:1679633929
Name:WEST MICHIGAN GASTROENTEROLOGY PLC
Entity Type:Organization
Organization Name:WEST MICHIGAN GASTROENTEROLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:231-726-5075
Mailing Address - Street 1:1675 LEAHY
Mailing Address - Street 2:SUITE 324B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5500
Mailing Address - Country:US
Mailing Address - Phone:231-726-5075
Mailing Address - Fax:231-722-1827
Practice Address - Street 1:1675 LEAHY
Practice Address - Street 2:SUITE 324B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-726-5075
Practice Address - Fax:231-722-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICM6445OtherRAILROAD MEDICARE
MI0F17616Medicare PIN