Healthcare Provider Details

I. General information

NPI: 1700524386
Provider Name (Legal Business Name): ELIZABETH NISPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S BOWER ST
GREENVILLE MI
48838-2614
US

IV. Provider business mailing address

4100 EMBASSY DR SE STE 200
GRAND RAPIDS MI
49546-2416
US

V. Phone/Fax

Practice location:
  • Phone: 866-542-7910
  • Fax:
Mailing address:
  • Phone: 616-975-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301517754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: