Provider Demographics
NPI:1457145476
Name:DUVALL, ALISA (MD)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:DUVALL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:LOEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 W OAK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2155
Mailing Address - Country:US
Mailing Address - Phone:616-754-4685
Mailing Address - Fax:
Practice Address - Street 1:1202 W OAK ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2155
Practice Address - Country:US
Practice Address - Phone:616-754-4685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program