Provider Demographics
NPI:1205416898
Name:REITSMA, ALYSSA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NICOLE
Last Name:REITSMA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1455 S LAPEER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1468
Mailing Address - Country:US
Mailing Address - Phone:248-693-3551
Mailing Address - Fax:248-693-4643
Practice Address - Street 1:1455 S LAPEER RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1468
Practice Address - Country:US
Practice Address - Phone:248-693-3551
Practice Address - Fax:248-963-4643
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2024-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301511010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine