Organization · Type 2 NPI

Spectrum Health Primary Care Partners

Pediatric Neurodevelopmental Disabilities Physician · Grand Rapids, MI

NPI number 1578860912 Active

Practice location

700 Fuller Ave NE
Grand Rapids, MI 49503-1918

Call (616) 365-2310 Map

Mailing address

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

Specialties and licenses

Taxonomy	Code	License
Cardiovascular Disease Physician	207RC0000X	None listed
Pediatric Neurodevelopmental Disabilities Physician Primary	2080P0008X	None listed

Pediatric Neurodevelopmental Disabilities Physician: A pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina bifida, autism, and other chronic neurologic conditions.

8 other providers at this address

Other pediatric neurodevelopmental disabilities physician providers in Grand Rapids

Spectrum Health Primary Care PartnersPediatric Neurodevelopmental Disabilities Physician Grand Rapids, MI NPI 1922582196

See all in Grand Rapids →

NPI record

NPI: 1578860912
Entity type: Organization (Type 2)
Issued: Feb 22, 2011
Last updated: Oct 31, 2023
Status: Active
Subpart: Yes of Spectrum Health Primary Care Partners

Other names

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Corewell Health Medical Group West · doing business as

Authorized official

Polly Krywanski
SVP, Finance
(616) 486-2253

Verify this record

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 1578860912

Spectrum Health Primary Care Partners's National Provider Identifier is 1578860912, issued on Feb 22, 2011. The primary taxonomy on file is Pediatric Neurodevelopmental Disabilities Physician (2080P0008X), and the practice location is in Grand Rapids, MI. The record was last updated on Oct 31, 2023.