Healthcare Provider Details

I. General information

NPI: 1588844328
Provider Name (Legal Business Name): MELISSA VISSER P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W CENTRE AVE
PORTAGE MI
49024-4666
US

IV. Provider business mailing address

601 JOHN ST
KALAMAZOO MI
49007-5232
US

V. Phone/Fax

Practice location:
  • Phone: 269-324-4141
  • Fax: 269-324-2020
Mailing address:
  • Phone: 269-324-4141
  • Fax: 269-324-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005118
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: