Organization · Type 2 NPI

Sparrow Eaton Hospital

Adolescent Medicine (Family Medicine) Physician · Grand Ledge, MI

NPI number 1841079787 Active

Practice location

820 Spring St Ste 100
Grand Ledge, MI 48837-1834

Call (517) 925-5590 Map

Fax (517) 925-5590

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081

Specialties and licenses

Taxonomy	Code	License
Clinical Social Worker	1041C0700X	None listed
Adolescent Medicine (Family Medicine) Physician Primary	207QA0000X	None listed

Adolescent Medicine (Family Medicine) Physician: A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.

NPI record

NPI: 1841079787
Entity type: Organization (Type 2)
Issued: Sep 28, 2023
Last updated: Nov 8, 2024
Status: Active
Subpart: Yes of Sparrow Health System

Other names

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Grand Ledge Public Schools Health Center · doing business as

Authorized official

Misty Gunter Russian
Supervisor, Provider Enrollment
(517) 253-6308

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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 1841079787

Sparrow Eaton Hospital's National Provider Identifier is 1841079787, issued on Sep 28, 2023. The primary taxonomy on file is Adolescent Medicine (Family Medicine) Physician (207QA0000X), and the practice location is in Grand Ledge, MI. The record was last updated on Nov 8, 2024.