Individual
LISA VAN DORP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4000 WELLNESS DR, MIDLAND, MI 48670-2000
(989) 839-3000
Mailing address
5802 S HERITAGE CT, MIDLAND, MI 48640-3128
(586) 917-8237
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601007489
MI
Other
Enumeration date
10/12/2015
Last updated
11/06/2019
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