Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301407462 | MI |
NPI | 1003804642 |
---|---|
Provider Name | Steven J Verkaik |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Hudsonville, MI 49426-9297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 06/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3239986 | (05) | MI |
B49426 | (02) | MI |