Provider Demographics
NPI:1730123506
Name:GRAND HAVEN BONE & JOINT, P.C.
Entity Type:Organization
Organization Name:GRAND HAVEN BONE & JOINT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-296-9100
Mailing Address - Street 1:1445 SHELDON RD
Mailing Address - Street 2:STE. G1
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2480
Mailing Address - Country:US
Mailing Address - Phone:616-296-9100
Mailing Address - Fax:616-296-0145
Practice Address - Street 1:1445 SHELDON RD
Practice Address - Street 2:STE. G1
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2480
Practice Address - Country:US
Practice Address - Phone:616-296-9100
Practice Address - Fax:616-296-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB067471207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4324025Medicaid
MIH45290Medicare UPIN
MI0N34110Medicare ID - Type Unspecified