Provider Demographics
NPI:1013118892
Name:WEST SHORE OBGYN PLLC
Entity type:Organization
Organization Name:WEST SHORE OBGYN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OBGYN
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-767-1775
Mailing Address - Street 1:1844 E APPLE AVE
Mailing Address - Street 2:SUITES B & C
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3881
Mailing Address - Country:US
Mailing Address - Phone:231-767-1775
Mailing Address - Fax:231-767-1776
Practice Address - Street 1:1844 E APPLE AVE
Practice Address - Street 2:SUITES B & C
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3881
Practice Address - Country:US
Practice Address - Phone:231-767-1775
Practice Address - Fax:231-767-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDW011812207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4262657Medicaid
MI4262657Medicaid
MIH09963Medicare UPIN