Dykstra, Russell Lee
Dykstra, Russell Lee is an individual health care provider with primary practice located at 904 S Washington Ave Suite 210, Holland MI 49423-7724. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Dykstra, Russell Lee can be contacted via phone (616) 392-8035.Contact Information
Primary practice address
904 S Washington Ave Suite 210
Holland MI 49423-7724
Phone: (616) 392-8035
Fax: (616) 392-7404
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | RD407281 | Michigan |
Profile Details
| NPI number | 1225091333 |
|---|---|
| LBN Legal business name | Dykstra, Russell Lee |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 10th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225091333 | NPPES |
| Michigan | MEDICAID | 3325734 10 |
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