Provider Demographics
NPI:1538766639
Name:CORPORATE OCCUPATIONAL HEALTH PC
Entity type:Organization
Organization Name:CORPORATE OCCUPATIONAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ILKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-285-2728
Mailing Address - Street 1:3501 LAKE EASTBROOK BLVD SE STE 144
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5939
Mailing Address - Country:US
Mailing Address - Phone:616-340-0936
Mailing Address - Fax:
Practice Address - Street 1:3501 LAKE EASTBROOK BLVD SE STE 144
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5939
Practice Address - Country:US
Practice Address - Phone:616-340-0936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty