BRIGHTWAVE PAIN THERAPY, PC (NPI# 1962062703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962062703 |
| Entity Type | Organization |
| Organization Name | BRIGHTWAVE PAIN THERAPY, PC |
| Practice Address |
751 Kenmoor Ave Se Grand Rapids MI 49546-2388 |
| Practice Telephone | 6166085551 |
| Mailing Telephone | 6166085551 |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2019-06-14 |
| Authorized Official Name | DR. DONALD E WILLMAN (PRESIDENT) |
| Authorized Official Telephone | 6166085551 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP3300X |
Clinic/Center Specialization: Pain |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| BrightWave Pain Therapy | Doing Business As Name - Organization |
| Street Address |
751 KENMOOR AVE SE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49546-2388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134120959 | Roseann Doney | Physical Therapy Assistant | 751 Kenmoor Ave Se, Suite H, Grand Rapids, MI 49546-2391 | 2005-08-02 |
| 1437593589 | Internal Medicine and Pediatrics of West Michigan, LLC | Internal Medicine | 751 Kenmoor Ave Se, Grand Rapids, MI 49546-2388 | 2013-04-19 |
| 1356677835 | Ravikumar K Shukla | Physical Therapist | 751 Kenmoor Ave Se, Suite # E, Grand Rapids, MI 49546-2388 | 2009-10-19 |
| 1174684120 | Defoe James Edgerle | Dentist | 751 Kenmoor Ave Se, Suite G, Grand Rapids, MI 49546-2388 | 2006-12-13 |
| 1114967809 | Catherine M Lisenbee | Audiologist | 751 Kenmoor Ave Se, Suite B, Grand Rapids, MI 49546-2391 | 2006-06-08 |
| 1578534699 | Casey R Bartman | Orthopaedic Surgery | 751 Kenmoor Ave Se, Grand Rapids, MI 49546-2391 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437762986 | Amanda Mae Ostrom | Speech-Language Pathologist | 710 Kenmore Ave Se, #110, Grand Rapids, MI 49546 | 2020-08-25 |
| 1063075562 | Kelly Lynn Ibarra | Counselor | 4467 Cascade Road Se, Suite #4479, Grand Rapids, MI 49546 | 2019-04-19 |
| 1891257036 | Jessica Matthews LLC | Counselor | 4127 Embassy Drive Se, Grand Rapids, MI 49546 | 2019-04-05 |
| 1326518531 | Neah Morgan | Technician | 4220 Burton St Se, Grand Rapids, MI 49546 | 2018-11-29 |
| 1316430267 | Michael John Benskey | Case Manager/Care Coordinator | 4065 Saladin St Se, Grand Rapids, MI 49546 | 2018-06-14 |
| 1679062772 | Smile Cascade, P.C. | Clinic/Center | 4505 Cascade Rd Se # A, Grand Rapids, MI 49546 | 2018-05-03 |
| 1720583289 | Jeromy Krogman | Counselor | 826 Parchment Drive Se, Grand Rapids, MI 49546 | 2018-03-27 |
| 1841792660 | Affordable Hearing Clinic | Hearing Instrument Specialist | 833 Kenmoor Ave Se Ste G, Grand Rapids, MI 49546 | 2018-03-07 |
| 1689176133 | Kelly Pines | Physical Therapist | 625 Kenmoor Ave Suite 306, Grand Rapids, MI 49546 | 2018-03-01 |
| 1467971440 | Deanna Elizabeth Saenz | Social Worker | 2100 Raybrook St Se Ste 300, Grand Rapids, MI 49546 | 2017-09-12 |
| Find all providers in zip 49546 | ||||
| Taxonomy Code | 261QP3300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Pain |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518106525 | Ronald P. Kufner M.d., P.C. | Clinic/Center | 5050 Cascade Rd Se, Suite C, Grand Rapids, MI 49546-3707 | 2009-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649813650 | Metro Med Pain Management & Rehab Plc | Clinic/Center | 4520 Firestone St Ste A, Dearborn, MI 48126-4602 | 2019-10-22 |
| 1295382976 | Care Recovery Clinic Pllc | Clinic/Center | 13530 Michigan Ave Ste 301, Dearborn, MI 48126-3555 | 2019-08-19 |
| 1902459860 | Comprehensive Care Pain Management, P.C. | Clinic/Center | 9001 15 Mile Rd Ste C, Sterling Heights, MI 48312-3621 | 2019-07-19 |
| 1386296077 | Michigan Institute of Musculoskeletal Medicine Pllc | Clinic/Center | 26206 W 12 Mile Rd Ste 200, Southfield, MI 48034-8500 | 2019-07-12 |
| 1740832930 | Heights Pain Management & Rehab Plc | Clinic/Center | 30671 Stephenson Hwy Ste D, Madison Heights, MI 48071-1635 | 2019-07-09 |
| 1609340215 | Michigan Orthopedic Spine & Interventionalist Pllc | Clinic/Center | 17290 Stonebrook Dr, Northville, MI 48168-4324 | 2019-01-16 |
| 1992204341 | Jawad A Shah Md PC | Clinic/Center | 4400 S Saginaw St Ste 1370, Flint, MI 48507-2668 | 2018-02-12 |
| 1508308750 | Mark Sobor, Md | Clinic/Center | 13560 76th St, Unit 2, South Haven, MI 49090-9483 | 2016-11-04 |
| 1316316771 | Advanced Rehab and Pain Management PC | Clinic/Center | 1820 Oak Ave, Muskegon, MI 49442-2408 | 2015-09-16 |
| 1154717106 | Excellent Pain Consultants | Clinic/Center | 15565 Northland Dr W Ste 304, Southfield, MI 48075-5313 | 2015-04-07 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49546 |
Please comment or provide details below to improve the information on BRIGHTWAVE PAIN THERAPY, 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.