Individual
MRS. MELISSA VISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
2600 W CENTRE AVE, PORTAGE, MI 49024-4666
(269) 324-4141
(269) 324-2020
Mailing address
601 JOHN ST, BOX 42, KALAMAZOO, MI 49007-5341
(269) 324-4141
(269) 324-2020
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005118
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104840529
BCBSM - BMG TAX ID
MI
05
—
1588844328
—
MI
Enumeration date
11/09/2007
Last updated
11/27/2023
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