Healthcare Provider Details

I. General information

NPI: 1609692680
Provider Name (Legal Business Name): JACOB BYLSMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 02/01/2026
Certification Date: 02/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S GETTY ST
MUSKEGON HEIGHTS MI
49444-1207
US

IV. Provider business mailing address

1 CAMPUS DR
ALLENDALE MI
49401-9401
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-9315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: