12th Street Pllc

NPI #1790470409 in Wayland, Michigan

Provider Information

NPI Number: 1790470409
Entity Type: Organization
Organization Name: 12th Street Pllc
Primary Specialty: Internal Medicine
Enumeration Date: Apr 7, 2023
Last Updated: Aug 15, 2023

Practice Location

Address: 3587 12TH ST
City: Wayland
State: Michigan
ZIP Code: 49348-9569
Phone: (616) 648-4933

Authorized Official

Name: JOEL VELDHOUSE, MD
Title: PHYSICIAN OWNER
Phone: (616) 648-4933

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X
Internal Medicine	207R00000X	Primary

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