Healthcare Provider Details

I. General information

NPI: 1891838157
Provider Name (Legal Business Name): MICHAEL R. DURCO MA, LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 SPARKS DR SE SUITE 103
GRAND RAPIDS MI
49546-6110
US

IV. Provider business mailing address

3949 SPARKS DR SE SUITE 103
GRAND RAPIDS MI
49546-6110
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-5850
  • Fax: 616-957-5853
Mailing address:
  • Phone: 616-957-5850
  • Fax: 616-957-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number410049 AND 310069
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6301005463
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: