Provider Demographics
NPI:1760454961
Name:DUFFEY, DAVID S (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:DUFFEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 GEZON PKWY SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9563
Mailing Address - Country:US
Mailing Address - Phone:616-252-4655
Mailing Address - Fax:616-252-0103
Practice Address - Street 1:5900 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9606
Practice Address - Country:US
Practice Address - Phone:616-252-7200
Practice Address - Fax:616-252-7830
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101011149OtherSTATE LICENSE
MI4639169Medicaid
MI3554110904OtherGROUP #
MID16078154Medicare PIN
MIF71234Medicare UPIN