Healthcare Provider Details

I. General information

NPI: 1033903273
Provider Name (Legal Business Name): ELLIOT MICHAEL ENSINK DO/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MICHIGAN ST NE FL 8
GRAND RAPIDS MI
49503-2531
US

IV. Provider business mailing address

275 MICHIGAN ST NE FL 8
GRAND RAPIDS MI
49503-2531
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-8810
  • Fax: 616-391-8897
Mailing address:
  • Phone: 616-391-8810
  • Fax: 616-391-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5151017302
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: