Optimum Health Clinic, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301073442 Issued in MI

Legal business name

OPTIMUM HEALTH CLINIC, PC

Practice address

305 Thomas St
Suite B
Allegan, MI 49010-9158

Phone

(269) 673-2179

NPI assigned

Mar 2, 2009

Last updated

Mar 2, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Laurie L Bourdo

Title

Billing Manager

Phone

(269) 673-2179

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235952000000",
    "number": "1275773343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 THOMAS ST",
            "address_2": "SUITE B",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490109158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 THOMAS ST",
            "address_2": "SUITE B",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490109158",
            "telephone_number": "269-673-2179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM HEALTH CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-02",
        "last_updated": "2009-03-02",
        "status": "A",
        "authorized_official_last_name": "BOURDO",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "269-673-2179"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301073442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.