Provider Demographics
NPI:1437122744
Name:ORTON, TRACY C (DO)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:ORTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8122
Mailing Address - Country:US
Mailing Address - Phone:616-994-2770
Mailing Address - Fax:616-920-6533
Practice Address - Street 1:3100 N WELLNESS DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8122
Practice Address - Country:US
Practice Address - Phone:616-994-2770
Practice Address - Fax:616-920-6533
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116144207KA0200X, 207YX0007X
MI5101017139207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437122744Medicaid
MO701000217OtherMO MEDICARE
MID16150188OtherMEDICARE PROVIDER NUMBER
MI0M74460208Medicare PIN
MO701000217OtherMO MEDICARE
MO1437122744Medicaid