Address Healthcare of Michigan PLLC
NPI 1043075294ActiveOrganization· Internal Medicine· Grand Rapids, MI
Internal Medicine in Grand Rapids, Michigan, registered in NPPES in February 2024. The authorized official on file is Jeffrey L. Wacksman, Authorized Official. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1043075294 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 16, 2024 |
| Last updated in NPPES | May 5, 2025 |
| Certified by provider | Apr 18, 2025 |
Specialties and licenses
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MI) |
|---|
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