| Executive Family And Sports | |
|
771 Kenmoor Ave Se Grand Rapids MI 49546-2370 | |
| (616) 734-0335 | |
| (616) 949-8540 |
| Full Name | Executive Family And Sports |
|---|---|
| Speciality | Family Medicine |
| Location | 771 Kenmoor Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Christopher Zielinski (PRESIDENT) |
| Authorized Official Contact | 6167340335 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Executive Family And Sports Po Box 8306 Kentwood MI 49518-8306 Ph: (616) 734-0335 | Executive Family And Sports 771 Kenmoor Ave Se Grand Rapids MI 49546-2370 Ph: (616) 734-0335 |
| NPI Number | 1336201565 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 12/18/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336201565 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101013068 (Michigan) | Primary |
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