Organization · Type 2 NPI

Spectrum Health Hospitals

Pediatric Hematology & Oncology Physician · St. Joseph, MI

NPI number 1154608115 Active

Practice location

3950 Hollywood Rd, Suite 240
St. Joseph, MI 49085-9159

Call (616) 267-1925 Map

Fax (616) 267-1005

Mailing address

100 Michigan St NE, Mc 845
Grand Rapids, MI 49503-2560

Specialties and licenses

Taxonomy	Code	License
Maternal & Fetal Medicine Physician	207VM0101X	None listed
Pediatric Hematology & Oncology Physician Primary	2080P0207X	None listed

Pediatric Hematology & Oncology Physician: A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases.

55 other providers at this address

NPI record

NPI: 1154608115
Entity type: Organization (Type 2)
Issued: Nov 4, 2011
Last updated: Nov 2, 2023
Status: Active
Subpart: Yes of Spectrum Health Hospitals

Other names

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Corewell Health Grand Rapids Hospitals · doing business as

Authorized official

Thomas Jurries
Director
(616) 486-6790

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1154608115

Spectrum Health Hospitals's National Provider Identifier is 1154608115, issued on Nov 4, 2011. The primary taxonomy on file is Pediatric Hematology & Oncology Physician (2080P0207X), and the practice location is in St. Joseph, MI. The record was last updated on Nov 2, 2023.