Provider Demographics
NPI:1942275540
Name:PONSTEIN, PAUL D (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:PONSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E SHERMAN BLVD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1867
Mailing Address - Country:US
Mailing Address - Phone:231-672-3746
Mailing Address - Fax:231-672-6786
Practice Address - Street 1:1560 E SHERMAN BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1867
Practice Address - Country:US
Practice Address - Phone:231-672-3746
Practice Address - Fax:231-672-6786
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101117840208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101117840OtherPDP STATE
MIPP007840OtherPDP BCBSMI
MIE26501Medicare UPIN