Provider Demographics
NPI:1104336759
Name:BELCASTRO, LINDSAY LEE
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:LEE
Last Name:BELCASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:LEE
Other - Last Name:BELCASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 VAN OMMEN DR STE C
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8085
Mailing Address - Country:US
Mailing Address - Phone:616-350-7781
Mailing Address - Fax:
Practice Address - Street 1:2450 VAN OMMEN DR STE C
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8085
Practice Address - Country:US
Practice Address - Phone:616-350-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist