MEDICARE: MRS. LINDSAY GRACE ISRAELS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101027248	MI

General Provider Information

NPI Number	:	1316576804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDSAY GRACE ISRAELS DO

Provider Business Mailing Address
First Line	:	5900 BYRON CENTER AVE SW
Second Line	:
City	:	WYOMING
State	:	MI
Zip	:	49519-9606
Country	:	US
Telephone Number	:	616-252-7200
Fax Number	:	616-252-4953

Provider Business Practice Location Address
First Line	:	2917 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9314
Country	:	US
Telephone Number	:	616-252-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	09/13/2023

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