NPI 1043075294 · live from the CMS NPI Registry
Address Healthcare Of Michigan PLLC
Internal Medicine in Grand Rapids, MI. National Provider Identifier 1043075294, active.
NPI record
| NPI | 1043075294 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Internal Medicine 207R00000X |
| Practice location | 600 Monroe Avenue Nw, Ste 104, Grand Rapids, MI 49503 |
| Practice phone | 616-366-4234 |
| Mailing address | 3940 Peninsular Drive Se, Ste 230, Grand Rapids, MI 49546 |
| Enumerated | February 16, 2024 |
| Last updated | May 5, 2025 |
| Authorized official | Jeffrey Wacksman, Authorized Official |
| Other names | Address Healthcare; Address Healthcare Of Michigan |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist | 152W00000X | — |
| Internal Medicine, Hospice and Palliative Medicine | 207RH0002X | — |
| 2084P0805X | — | |
| Podiatrist, Foot & Ankle Surgery | 213ES0103X | — |
| Nurse Practitioner, Adult Health | 363LA2200X | — |
| Internal Medicine primary | 207R00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.