Dimusto-Poortenga, Maria E

Dimusto-Poortenga, Maria E is an individual health care provider with primary practice located at 200 Jefferson Ave Se Nicu, Grand Rapids MI 49503-4502. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine. Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine is her primary health care specialty. Dimusto-Poortenga, Maria E can be contacted via phone (616) 752-6554.

Contact Information

Primary practice address
200 Jefferson Ave Se Nicu Grand Rapids MI 49503-4502
Phone: (616) 752-6554
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301068818 Michigan
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X 35C001071 Ohio
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X 1013940980 Michigan
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X ME141884 Florida
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X 4301068818 Michigan

Profile Details

NPI number 1013940980
LBN Legal business name Dimusto-Poortenga, Maria E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2006
Last updated Dec 5th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013940980 NPPES
Ohio MEDICAID 0031359
Ohio MEDICAID 4120849
Ohio MEDICAID 4877886

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