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General NPI Number Information
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NPI Number | 1437122744
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Entity Type | Individual
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Provider Name | TRACY C ORTON DO
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 3100 N WELLNESS DR
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City | HOLLAND
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State | MI
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Zip | 49424-8122
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Country | US
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Telephone | 616-994-2770
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Fax | 616-920-6533
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Provider Business Mailing Address
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Address Line | 3100 N WELLNESS DR
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City | HOLLAND
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State | MI
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Zip | 49424-8122
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Country | US
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Telephone | 616-994-2770
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Fax | 616-920-6533
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 116144
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 116144
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 5101017139
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License Number State | MI
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