Healthcare Provider Details

I. General information

NPI: 1568559086
Provider Name (Legal Business Name): SCOTT M TUINSTRA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 EAGLE PARK DR NE STE 102
GRAND RAPIDS MI
49525-4570
US

IV. Provider business mailing address

3350 EAGLE PARK DR NE STE 102
GRAND RAPIDS MI
49525-4570
US

V. Phone/Fax

Practice location:
  • Phone: 616-454-3465
  • Fax: 616-454-0954
Mailing address:
  • Phone: 616-454-3465
  • Fax: 616-454-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601003962
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: