Provider profile · NPI 1790470409

12th Street Pllc

Internal Medicine · Wayland, MI · NPI 1790470409 · No federal exclusion match

✔ Verified against the public CMS NPPES registry & HHS-OIG LEIE as of Jun 21, 2026. Source-linked, daily-refreshed. Public data only — no PHI.

Registry details

Type

Organization

Primary specialty

Internal Medicine

Enumerated

Apr 7, 2023

License(s)

Addresses on file

PurposeAddressCity/StatePhone
LOCATION3587 12TH ST Wayland, MI 49348-9569616-648-4933
MAILING3587 12TH ST Wayland, MI 49348-9569

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