Provider Demographics
NPI:1366446130
Name:GUSTAFSON, MARGARET E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:E
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:7 ATKINSON DR STE 200
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1917
Practice Address - Country:US
Practice Address - Phone:231-843-6767
Practice Address - Fax:231-843-6522
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040418207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMG040418OtherLICENSE #
MI2097699Medicaid
MIB44188Medicare UPIN
MI0533965Medicare PIN