Provider Demographics
NPI:1881692077
Name:BAKKER, DIRK A (MD)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:A
Last Name:BAKKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1445 SHELDON RD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2480
Mailing Address - Country:US
Mailing Address - Phone:616-296-9100
Mailing Address - Fax:616-296-0145
Practice Address - Street 1:1445 SHELDON RD
Practice Address - Street 2:SUITE G1
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2480
Practice Address - Country:US
Practice Address - Phone:616-296-9100
Practice Address - Fax:616-296-0145
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301067471207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4324025Medicaid
MI4324025Medicaid
MIH45290Medicare UPIN