Provider Demographics
NPI:1528085040
Name:REUSCH, RONALD W (PA C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:W
Last Name:REUSCH
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 RIVERTOWN POINT CT SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3076
Mailing Address - Country:US
Mailing Address - Phone:616-257-3344
Mailing Address - Fax:616-257-1491
Practice Address - Street 1:3434 RIVERTOWN POINT CT SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3076
Practice Address - Country:US
Practice Address - Phone:616-257-3344
Practice Address - Fax:616-257-1491
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003430207N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601003430OtherSTATE LICENSE #
MI0N86210003Medicare ID - Type Unspecified