WEST MICHIGAN ADDICTION CONSULTANTS, PC (NPI# 1588821433) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588821433 |
| Entity Type | Organization |
| Organization Name | WEST MICHIGAN ADDICTION CONSULTANTS, PC |
| Practice Address |
3001 Fuller Ave Ne Suite 1 Grand Rapids MI 49505-3247 |
| Practice Telephone | 6163658800 |
| Practice Fax Number | 6163657979 |
| Mailing Telephone | 6163658800 |
| Mailing Fax Number | 6163657979 |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2008-05-19 |
| Authorized Official Name | BRUCE BAKER (PHYSICIAN) |
| Authorized Official Telephone | 6163658800 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
100005 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS | 0504118411 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003053133 | West Michigan Addiction Consultants, PC | Substance Abuse Rehabilitation Facility | 3001 Fuller Ave Ne, Suite 1, Grand Rapids, MI 49505-3204 | 2009-01-12 |
| Street Address |
3001 FULLER AVE NE SUITE 1 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49505-3247 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003053133 | West Michigan Addiction Consultants, PC | Substance Abuse Rehabilitation Facility | 3001 Fuller Ave Ne, Suite 1, Grand Rapids, MI 49505-3204 | 2009-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285276097 | Molly Beth Kerkstra | Home Health Aide | 1115 Ball Ave Nw, Grand Rapids, MI 49505 | 2019-10-14 |
| 1154849677 | Roshawn Nichol Whitley | Technician | 891 Maryland Ave, Grand Rapids, MI 49505 | 2017-09-05 |
| 1447778923 | Kelly Benzin-brinks | Social Worker | 1965 3 Mile Rd Ne, Grand Rapids, MI 49505 | 2017-09-05 |
| 1033560404 | Taylor Nolan Boyd | Speech-Language Pathologist | 400 Ann St Ne Ste 106a, Grand Rapids, MI 49505 | 2016-06-28 |
| 1023465002 | Calvin Athy | Counselor | 1101 Ballave Ne, Grand Rapids, MI 49505 | 2016-05-19 |
| 1821456682 | Kelly Van Huisen | Counselor | 1115 Ball Avenue Ne, Building B, Grand Rapids, MI 49505 | 2016-02-08 |
| 1780051102 | Mark Squeteri | Social Worker | 1345 Monroe Ave Nw Ste 234, Grand Rapids, MI 49505 | 2015-09-02 |
| 1346637337 | Shelby Fullington | Social Worker | 1011 Ball Ave Ne, Grand Rapids, MI 49505 | 2015-04-17 |
| 1457745325 | Lester Anderson II | Social Worker | 1115 Ball Ave, Grand Rapids, MI 49505 | 2015-03-27 |
| 1730570151 | Nicole Brown | Counselor | 1345 Monroe Ave Nw Ste 204, Grand Rapids, MI 49505 | 2015-02-06 |
| Find all providers in zip 49505 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
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| 1013367473 | East & West Physicians PC | Internal Medicine | 20905 Greenfield Rd Ste 608, Southfield, MI 48075-5355 | 2016-06-16 |
| 1033445861 | Ayad M George, Pllc | Internal Medicine | 2132 Cedar St, Holt, MI 48842-1458 | 2009-10-29 |
| 1922108927 | Rudy Jerome Vervaeke | Internal Medicine | 21420 Harper Ave, Suite 2, Saint Clair Shores, MI 48080-3607 | 2006-09-22 |
| 1730727850 | Dearborn Pain Center Pllc | Internal Medicine | 624 E 9 Mile Rd, Hazel Park, MI 48030-1842 | 2019-12-19 |
| 1063069359 | Faster Care Connor Creek, Pllc | Internal Medicine | 4777 E Outer Dr, Detroit, MI 48234-3241 | 2019-08-21 |
| 1356869572 | America Recovery Center, Pllc | Internal Medicine | 20217 Ann Arbor Trl, Dearborn Heights, MI 48127-2692 | 2017-09-07 |
| 1356793954 | Iha Health Services Corporation | Internal Medicine | 5333 Mcauley Dr Rm 5011, Ypsilanti, MI 48197-1003 | 2016-07-07 |
| 1770967226 | Newhorizon Center LLC | Internal Medicine | 555 W Crosstown Pkwy, Suite 201, Kalamazoo, MI 49008-1999 | 2015-07-15 |
| 1942618228 | Changes | Internal Medicine | 19940 Conant St, Detroit, MI 48234-1494 | 2014-07-30 |
| 1033434253 | Elizabeth Bulat | Internal Medicine | 37595 7 Mile Rd, # 240, Livonia, MI 48152-1003 | 2010-03-30 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49505 |
Please comment or provide details below to improve the information on WEST MICHIGAN ADDICTION CONSULTANTS, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.