| Standale Family Physicians | |
|
3863 Lake Michigan Dr Nw Grand Rapids MI 49534-4520 | |
| (616) 453-2429 | |
| (616) 453-8340 |
| Full Name | Standale Family Physicians |
|---|---|
| Speciality | Family Medicine |
| Location | 3863 Lake Michigan Dr Nw, Grand Rapids, Michigan |
| Authorized Official Name and Position | Leonard A Lewis (MEMBER) |
| Authorized Official Contact | 6164532429 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Standale Family Physicians 3863 Lake Michigan Dr Nw Grand Rapids MI 49534-4520 Ph: (616) 453-2429 | Standale Family Physicians 3863 Lake Michigan Dr Nw Grand Rapids MI 49534-4520 Ph: (616) 453-2429 |
| NPI Number | 1659408029 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 03/28/2008 |
| Medicare PECOS PAC ID | 4082808076 |
|---|---|
| Medicare Enrollment ID | O20101103001187 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659408029 | NPI | - | NPPES |
| 2675738 | Medicaid | MI | |
| 2675756 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Leonard A Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174581300 PECOS PAC ID: 2163616152 Enrollment ID: I20101103001245 |
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