| Sedara Mae Healthcare Clinic, Llc | |
|
1167 Madison Ave Se Mailbox 5 Grand Rapids MI 49507-1200 | |
| (616) 301-1020 | |
| Not Available |
| Full Name | Sedara Mae Healthcare Clinic, Llc |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 1167 Madison Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Lisa M Lucas (PRACTITIONER) |
| Authorized Official Contact | 8003634661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sedara Mae Healthcare Clinic, Llc Po Box 8862 Kentwood MI 49518-8862 Ph: (616) 301-1020 | Sedara Mae Healthcare Clinic, Llc 1167 Madison Ave Se Mailbox 5 Grand Rapids MI 49507-1200 Ph: (616) 301-1020 |
| NPI Number | 1265875892 |
|---|---|
| Provider Enumeration Date | 04/12/2013 |
| Last Update Date | 04/25/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265875892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 4704237090 (Michigan) | Primary |
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