| Kentwood Family Physicians Pc | |
|
5070 Cascade Rd Se Suite 250 Grand Rapids MI 49546-8422 | |
| (616) 281-9066 | |
| (616) 281-0539 |
| Full Name | Kentwood Family Physicians Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 5070 Cascade Rd Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Bruce M Baker (PRESIDENT) |
| Authorized Official Contact | 6162819066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentwood Family Physicians Pc 5070 Cascade Rd Se Suite 250 Grand Rapids MI 49546-8422 Ph: (616) 281-9066 | Kentwood Family Physicians Pc 5070 Cascade Rd Se Suite 250 Grand Rapids MI 49546-8422 Ph: (616) 281-9066 |
| NPI Number | 1598845794 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 11/20/2007 |
| Medicare PECOS PAC ID | 3779597562 |
|---|---|
| Medicare Enrollment ID | O20060201000079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598845794 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Bruce Martin Baker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467532648 PECOS PAC ID: 2860406659 Enrollment ID: I20060201000113 |
| Provider Name | Susan Lynn Baker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205916475 PECOS PAC ID: 5597779397 Enrollment ID: I20060201000168 |
| Provider Name | David L Byington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962582155 PECOS PAC ID: 6507870318 Enrollment ID: I20060201000185 |
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