Sixty Fourth Street LLC
NPI #1164538286 in Byron Center, Michigan
Provider Information
- NPI Number
- 1164538286
- Entity Type
- Organization
- Organization Name
- Sixty Fourth Street LLC
- Primary Specialty
- Clinic/Center - Ambulatory Surgical
- Enumeration Date
- Aug 22, 2006
- Last Updated
- Apr 23, 2018
Practice Location
- Address
- 2373 64TH ST SW
- Address 2
- SUITE 2200
- City
- Byron Center
- State
- Michigan
- ZIP Code
- 49315-7974
- Phone
- (616) 685-3975
Authorized Official
- Name
- ANDREW LIVINGSTON, MD
- Title
- MEDICAL DIRECTOR
- Phone
- (616) 685-3975
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Ambulatory Surgical — Ambulatory Surgical |
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