Individual
LISA MARIE HYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
655 KENMOOR AVE SE STE 201, GRAND RAPIDS, MI 49546-8604
(616) 920-0825
(616) 920-0830
Mailing address
7400 KIRKWOOD TRL SE, ALTO, MI 49302-9187
(616) 813-6634
(989) 401-4245
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006602
MI
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/12/2013
Last updated
11/27/2023
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