Provider Demographics
NPI:1144554247
Name:SOFT MEDICAL, PC
Entity type:Organization
Organization Name:SOFT MEDICAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:HERD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-532-7638
Mailing Address - Street 1:4455 WILSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2366
Mailing Address - Country:US
Mailing Address - Phone:616-532-7638
Mailing Address - Fax:616-249-8346
Practice Address - Street 1:4455 WILSON AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2366
Practice Address - Country:US
Practice Address - Phone:616-532-7638
Practice Address - Fax:616-249-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI089203207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty