| Internal Medicine Of West Michigan Pllc | |
|
3200 Eagle Park Dr Ne Suite 102 Grand Rapids MI 49525-7057 | |
| (616) 285-9090 | |
| (616) 285-7947 |
| Full Name | Internal Medicine Of West Michigan Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3200 Eagle Park Dr Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Elizabeth A Kozak (PARTNER) |
| Authorized Official Contact | 6162859090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Of West Michigan Pllc 3200 Eagle Park Dr Ne Suite 102 Grand Rapids MI 49525-7057 Ph: (616) 285-9090 | Internal Medicine Of West Michigan Pllc 3200 Eagle Park Dr Ne Suite 102 Grand Rapids MI 49525-7057 Ph: (616) 285-9090 |
| NPI Number | 1619028412 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 10/25/2024 |
| Medicare PECOS PAC ID | 9335243484 |
|---|---|
| Medicare Enrollment ID | O20070329000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619028412 | NPI | - | NPPES |
| G02811 | Other | MI | BLUE CROSS GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Michigan) | Primary |
| Provider Name | Elizabeth Kozak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811076805 PECOS PAC ID: 9234233388 Enrollment ID: I20070329000031 |
| Provider Name | Mary S Richardson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760561740 PECOS PAC ID: 8325142474 Enrollment ID: I20070329000052 |
| Provider Name | David A Listello |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1508973538 PECOS PAC ID: 0244246098 Enrollment ID: I20071218000184 |
| Provider Name | Christopher James Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205276383 PECOS PAC ID: 3274852975 Enrollment ID: I20160712000748 |
| Provider Name | Andrew R Izzo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639699481 PECOS PAC ID: 1355610114 Enrollment ID: I20200721000225 |
| Provider Name | Danielle Stephanie Strunk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336776566 PECOS PAC ID: 6507265964 Enrollment ID: I20231221000434 |
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