Provider Demographics
NPI:1710199302
Name:ASTHMA NETWORK OF WEST MICHIGAN
Entity Type:Organization
Organization Name:ASTHMA NETWORK OF WEST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-957-1912
Mailing Address - Street 1:309 JEFFERSON AVE SE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4558
Mailing Address - Country:US
Mailing Address - Phone:616-685-1430
Mailing Address - Fax:616-685-1437
Practice Address - Street 1:309 JEFFERSON AVE SE
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4558
Practice Address - Country:US
Practice Address - Phone:616-685-1430
Practice Address - Fax:616-685-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management