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Contact Information

ADDRESS HEALTHCARE OF MICHIGAN PLLC
600 MONROE AVENUE NW
STE 104
GRAND RAPIDS, MI49503-1470
 Phone: 616-366-4234
 Fax: 855-548-4481
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Adult Health

363LA2200X 50 Nurse Practitioner
 

Geriatric Psychiatry

2084P0805X 86 Physician/Neuropsychiatry
 

Hospice and Palliative Medicine

207RH0002X 11 Physician/Internal Medicine
 

Optometrist

152W00000X 41 Optometry
 

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
Indicates primary specialty

NPI Profile & details for ADDRESS HEALTHCARE OF MICHIGAN PLLC

NPI Number 1043075294
LBN Legal business name ADDRESS HEALTHCARE OF MICHIGAN PLLC
Authorized official JEFFREY WACKSMAN - (AUTHORIZED OFFICIAL)
Entity Organization
Organization subpart 1 No
Enumeration date 02/16/2024
Last updated 05/05/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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