Healthcare Provider Details

I. General information

NPI: 1578054680
Provider Name (Legal Business Name): MELISSA A DUIMSTRA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E MT GARFIELD RD
MUSKEGON MI
49444-9733
US

IV. Provider business mailing address

1050 W WESTERN AVE STE 400
MUSKEGON MI
49441-1666
US

V. Phone/Fax

Practice location:
  • Phone: 231-728-3442
  • Fax:
Mailing address:
  • Phone: 231-728-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101025150
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number5101025150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: