Healthcare Provider Details

I. General information

NPI: 1699726356
Provider Name (Legal Business Name): DAVID A TUINSTRA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W KILBOURN AVE SUITE 301
MILWAUKEE WI
53233-5323
US

IV. Provider business mailing address

1218 W KILBOURN AVE STE 301
MILWAUKEE WI
53233-1325
US

V. Phone/Fax

Practice location:
  • Phone: 414-765-0010
  • Fax: 414-276-1758
Mailing address:
  • Phone: 414-765-0010
  • Fax: 414-276-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number658
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: