Healthcare Provider Details

I. General information

NPI: 1508654302
Provider Name (Legal Business Name): DAMIAN MINA BESADA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. MINA SAMIR LOTFY BESADA

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE AVE SE # 4000
GRAND RAPIDS MI
49503-4692
US

IV. Provider business mailing address

300 LAFAYETTE AVE SE STE 4000
GRAND RAPIDS MI
49503-4692
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6922
  • Fax: 616-685-5101
Mailing address:
  • Phone: 616-685-6922
  • Fax: 616-685-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: