Provider Demographics
NPI:1548334576
Name:SCHOLTEN, DONALD J (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:SCHOLTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4069 LAKE DR SE
Practice Address - Street 2:SUITE 117
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8816
Practice Address - Country:US
Practice Address - Phone:616-459-4601
Practice Address - Fax:616-459-0200
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDS039516208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDS039516OtherBCBS
MI1548334576Medicaid
MI104745635Medicaid
MI1558407189OtherSPECTRUM HEALTH CORP NPI
MI0M74460348Medicare PIN
MI1558407189OtherSPECTRUM HEALTH CORP NPI
MI1548334576Medicaid
MIDS039516OtherBCBS
MIC36179034Medicare PIN