Individual
TRACY C ORTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3100 N WELLNESS DR, HOLLAND, MI 49424-8122
(616) 994-2770
(616) 920-6533
Mailing address
3100 N WELLNESS DR, HOLLAND, MI 49424-8122
(616) 994-2770
(616) 920-6533
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
116144
MO
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
116144
MO
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
5101017139
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437122744
—
MI
01
—
701000217
MO MEDICARE
MO
01
—
D16150188
MEDICARE PROVIDER NUMBER
MI
Enumeration date
02/08/2006
Last updated
10/20/2020
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