Provider Demographics
NPI:1992801138
Name:GASTROENTEROLOGY INSTITUTE OF WEST MICHIGAN PC
Entity type:Organization
Organization Name:GASTROENTEROLOGY INSTITUTE OF WEST MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUKAT
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-459-6146
Mailing Address - Street 1:4100 EMBASSY DR SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2416
Mailing Address - Country:US
Mailing Address - Phone:616-459-6146
Mailing Address - Fax:616-459-9277
Practice Address - Street 1:1430 MICHIGAN ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2006
Practice Address - Country:US
Practice Address - Phone:616-459-6146
Practice Address - Fax:616-459-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICE4135OtherRAILROAD MEDICARE
MI0D11782OtherBCBS
MI1082851Medicaid
MIB44153Medicare UPIN
MI1082851Medicaid