Individual
BRYAN DALE VISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7901 S 12TH ST, SUITE #200, PORTAGE, MI 49024-3831
(269) 372-7200
(269) 372-1630
Mailing address
7901 S 12TH ST, SUITE #200, PORTAGE, MI 49024-3831
(269) 372-7200
(269) 372-1630
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301047094
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2891670
—
MI
Enumeration date
09/29/2006
Last updated
04/09/2025
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