Basic Information
| Provider Information | |||||||||
| NPI: | 1336101260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZUIDEMA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MICHIGAN ST NE | ||||||||
| Address2: | MC 845 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164866790 | ||||||||
| FaxNumber: | 6164866702 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MICHIGAN ST NE | ||||||||
| Address2: | SUITE 5200 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163913681 | ||||||||
| FaxNumber: | 6163918670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 4301041824 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1982467 | 05 | MI | MEDICAID | 1558407189 | 01 | MI | GROUP NPI | OTHER | 1922090554 | 01 | MI | GROUP NPI | OTHER | 160D162280 | 01 | MI | BCBS GROUP | OTHER |