Provider Demographics
NPI:1568559086
Name:TUINSTRA, SCOTT M (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:TUINSTRA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3299 N WELLNESS DR
Mailing Address - Street 2:BUILDING C; SUITE 240
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7269
Mailing Address - Country:US
Mailing Address - Phone:616-738-4420
Mailing Address - Fax:616-738-4432
Practice Address - Street 1:3299 N WELLNESS DR
Practice Address - Street 2:BUILDING C; SUITE 240
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7269
Practice Address - Country:US
Practice Address - Phone:616-738-4420
Practice Address - Fax:616-738-4432
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003962363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1407010792OtherBXMI
MIOD14869OtherGROUP PTAN - OAM
MIST003962OtherSTATE LICENSE
MI104721043Medicaid
MIST003962OtherSTATE LICENSE
MID14869123Medicare PIN