Provider Demographics
NPI:1033374368
Name:DIRKSE, RONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:DIRKSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12978 JAMES ST.
Mailing Address - Street 2:STE 10
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424
Mailing Address - Country:US
Mailing Address - Phone:616-399-7005
Mailing Address - Fax:616-399-7150
Practice Address - Street 1:12978 JAMES ST.
Practice Address - Street 2:STE 10
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424
Practice Address - Country:US
Practice Address - Phone:616-399-7005
Practice Address - Fax:616-399-7150
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0322272084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry