HomeNPI Verification

NPI Verification

National Provider Identifier: 1790470409

12th Street PLLC

Organization

Primary Specialty

Internal Medicine

Code: 207R00000X

All Specialties (2)

Pediatrics

Code: 208000000X

Internal Medicine

Code: 207R00000X

Primary

Practice Address

3587 12TH ST

WAYLAND, MI 493489569

Phone: 616-648-4933

NPI Enumeration Date

April 7, 2023

NPI Number

1790470409

Data sourced from the official CMS NPPES Registry. This information is provided by the Centers for Medicare & Medicaid Services and is updated regularly.

View on CMS NPPES Registry