Healthcare Provider Details

I. General information

NPI: 1174085799
Provider Name (Legal Business Name): LINDSEY KAITLYN DUROWOJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4502
US

IV. Provider business mailing address

PO BOX 9186
LONGVIEW TX
75608-9186
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6258
  • Fax:
Mailing address:
  • Phone: 903-663-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301513886
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: