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General NPI Number Information
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NPI Number | 1194771824
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Entity Type | Individual
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Provider Name | DAVID PASTOOR MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 4478 DOWLING ST
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City | MONTAGUE
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State | MI
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Zip | 49437-1201
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Country | US
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Telephone | 231-894-4531
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Fax | 231-894-8158
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Provider Business Mailing Address
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Address Line | 5511 W US HIGHWAY 10
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City | LUDINGTON
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State | MI
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Zip | 49431-2455
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Country | US
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Telephone | 231-843-1553
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Fax | 231-845-5515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301053688
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License Number State | MI
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