Provider Demographics
NPI:1861557969
Name:LIGON, DORSEY (MD)
Entity type:Individual
Prefix:DR
First Name:DORSEY
Middle Name:
Last Name:LIGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DORSEY
Other - Middle Name:
Other - Last Name:LIGON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
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 1:80 68TH ST SE
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6980
Practice Address - Country:US
Practice Address - Phone:616-532-1410
Practice Address - Fax:616-532-5017
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037012207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI207V00000XOtherTAXONOMY
MID91330Medicare UPIN
MIAL7701609OtherDEA
MIDL037012OtherSTATE LICENSE