Provider Demographics
NPI:1881789980
Name:WKQ, INC
Entity type:Organization
Organization Name:WKQ, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:GRASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-744-4743
Mailing Address - Street 1:420 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445
Mailing Address - Country:US
Mailing Address - Phone:231-744-4743
Mailing Address - Fax:
Practice Address - Street 1:420 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445
Practice Address - Country:US
Practice Address - Phone:231-744-4743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F160194Medicare ID - Type Unspecified