Provider Demographics
NPI:1194771824
Name:PASTOOR, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PASTOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:5511 W US HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2455
Mailing Address - Country:US
Mailing Address - Phone:231-843-1553
Mailing Address - Fax:231-845-5515
Practice Address - Street 1:4478 DOWLING ST
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-1201
Practice Address - Country:US
Practice Address - Phone:231-894-4531
Practice Address - Fax:231-894-8158
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDP053688OtherLICENSE
P00727292OtherRAIL ROAD MEDICARE
MI5409154Medicaid
MIN85680011Medicare PIN
MIF04711Medicare UPIN