Healthcare Provider Details

I. General information

NPI: 1760454961
Provider Name (Legal Business Name): DAVID S DUFFEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1183 ENNESS DR
STANTON MI
48888-9737
US

IV. Provider business mailing address

1183 ENNESS DR
STANTON MI
48888-9737
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7200
  • Fax: 616-252-7830
Mailing address:
  • Phone: 616-202-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101011149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: