Individual
DR. JASON BARRETT VAN ITTERSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6225 PRAIRIE ST, NORTON SHORES, MI 49444-7831
(231) 798-9500
(231) 798-9533
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301074360
MI
207NS0135X
Procedural Dermatology Physician
JV074360
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4532162
—
MI
Enumeration date
07/24/2006
Last updated
03/28/2024
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