Healthcare Provider Details

I. General information

NPI: 1265724603
Provider Name (Legal Business Name): BENJAMIN J VISGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E SHERMAN BLVD SUITE 2400
MUSKEGON MI
49444-1871
US

IV. Provider business mailing address

PO BOX 1847
MUSKEGON MI
49443-1847
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-6336
  • Fax: 231-672-6335
Mailing address:
  • Phone: 231-727-5211
  • Fax: 231-727-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101019204
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5101019204
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: