Individual
MR. KEITH T HUSTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 MICHIGAN ST NE, MC-039, GRAND RAPIDS, MI 49503-2560
(616) 486-2196
Mailing address
100 MICHIGAN ST NE, MC-039, GRAND RAPIDS, MI 49503-2560
(616) 486-2196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004306
MI
Other
Enumeration date
12/12/2006
Last updated
11/30/2015
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