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NPI Code Detail

MEDICARE: DALTON SOVINE PA

MEDICARE: DALTON SOVINE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601013718MI

General Provider Information

NPI Number : 1225854060
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALTON SOVINE PA
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE
Second Line : MC 845
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8501 MEADOW CRK
Second Line :
City : ROCKFORD
State : MI
Zip : 49341-7524
Country : US
Telephone Number : 616-825-7625
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2024
Last Update Date : 04/30/2026

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Directions to “ DALTON SOVINE PA” Practice Location

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