Grand Rapids Thoracic Surgery, PLLC

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

4301104138 Issued in MI

Legal business name

GRAND RAPIDS THORACIC SURGERY, PLLC

Practice address

4500 Cascade Rd SE
Suite 210
Grand Rapids, MI 49546-3665

Phone

(616) 259-7341

Fax

(616) 259-7642

NPI assigned

Dec 30, 2015

Last updated

Dec 30, 2015By 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

Lourens J. Willekes II, M.D.

Title

Owner

Phone

(616) 259-7341

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1451433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451433600000",
    "number": "1336504760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 CASCADE RD SE",
            "address_2": "SUITE 210",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463665",
            "telephone_number": "616-259-7341",
            "fax_number": "616-259-7642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 CASCADE RD SE",
            "address_2": "SUITE 210",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463665",
            "telephone_number": "616-259-7341",
            "fax_number": "616-259-7642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RAPIDS THORACIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-30",
        "last_updated": "2015-12-30",
        "status": "A",
        "authorized_official_last_name": "WILLEKES",
        "authorized_official_first_name": "LOURENS",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-259-7341",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MI",
            "license": "4301104138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Grand Rapids Vision Therapy LLC (Wow Vision Therapy)
• Grand Rapids Wellness, PC
• Grand Rapids Womens Health PC
• Grand Ridge Family Dentistry

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; 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.