Healthcare Provider Details

I. General information

NPI: 1336589365
Provider Name (Legal Business Name): JUSTIN DANIEL HOUSEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 FULLER AVE NE STE C
GRAND RAPIDS MI
49503-1991
US

IV. Provider business mailing address

465 FULLER AVE NE STE C
GRAND RAPIDS MI
49503-1991
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-5006
  • Fax:
Mailing address:
  • Phone: 616-888-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMC-2002
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME170255
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberU8196
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301102999
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: