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Contact Information

MARIA E DIMUSTO POORTENGA, MD
200 JEFFERSON AVE SE
NICU
GRAND RAPIDS, MI49503-4502
 Phone: 616-752-6554
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neonatal-Perinatal Medicine

2080N0001X 37 Physician/Pediatric Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for MARIA E DIMUSTO POORTENGA · (Female)

NPI # 1013940980
Status Active
Credentials MD
Entity Individual
Enumeration date 07/07/2006
Last updated 12/05/2023 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • FL License # ME141884
  • MI License # 1013940980
  • MI License # 4301068818
  • OH License # 35C001071
  • MI Medicaid 4120849
  • MI Medicaid 4877886
  • OH Medicaid 0031359
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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