Individual
JOHN A DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3019 COIT AVE NE, GRAND RAPIDS, MI 49505-3376
(616) 365-9575
Mailing address
2074 126TH AVE, HOPKINS, MI 49328-9768
(616) 365-9575
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601001358
MI
Other
Enumeration date
07/27/2006
Last updated
07/08/2007
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