NPIMap

Organization Active NPI

Spectrum Health Hospitals

Doing business as Corewell Health Grand Rapids Hospitals

  • Pediatric Cardiology Physician
  • Grand Blanc, MI
National Provider Identifier
1508167057
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
Legal business name
SPECTRUM HEALTH HOSPITALS
Doing business as
Corewell Health Grand Rapids Hospitals
Practice address
8273 S Saginaw St
Suite B
Grand Blanc, MI 48439-2465
Phone
(810) 953-5622
NPI assigned
Nov 15, 2010
Last updated
Nov 2, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECTRUM HEALTH HOSPITALSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Authorized official

Name
Polly Krywanski
Title
SVP of Finance
Phone
(616) 486-2253

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X NU Primary

Addresses

Primary practice location

8273 S Saginaw St
Suite B
Grand Blanc, MI 48439-2465

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

Other names 1

  • Corewell Health Grand Rapids Hospitals Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grand Rapids Pediatrics87 organizations share this tax ID, including this one
Part of
Grand Rapids Pediatrics

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1289779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1508167057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8273 S SAGINAW ST",
            "address_2": "SUITE B",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484392465",
            "telephone_number": "810-953-5622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH HOSPITALS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRUM HEALTH HOSPITALS",
        "enumeration_date": "2010-11-15",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "KRYWANSKI",
        "authorized_official_first_name": "POLLY",
        "authorized_official_title_or_position": "SVP OF FINANCE",
        "authorized_official_telephone_number": "616-486-2253"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Grand Rapids Hospitals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Blanc, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; 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.