Individual
MARIA E DIMUSTO-POORTENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 JEFFERSON AVE SE, NICU, GRAND RAPIDS, MI 49503-4502
(616) 752-6554
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 913-1818
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301068818
MI
2080N0001X
Neonatal-Perinatal Medicine Physician
1013940980
MI
2080N0001X
Neonatal-Perinatal Medicine Physician
35C001071
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
4301068818
MI
2080N0001X
Neonatal-Perinatal Medicine Physician
ME141884
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0031359
—
OH
05
—
4120849
—
MI
05
—
4877886
—
MI
Enumeration date
07/07/2006
Last updated
12/05/2023
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