Provider Demographics
NPI:1407817349
Name:KUIPER, MATTHEW LARS (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LARS
Last Name:KUIPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5555 GLENWOOD HILLS PKWY SE STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2091
Mailing Address - Country:US
Mailing Address - Phone:616-940-2662
Mailing Address - Fax:616-940-1965
Practice Address - Street 1:3770 GLENKERRY CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-0700
Practice Address - Country:US
Practice Address - Phone:269-329-2887
Practice Address - Fax:269-329-2805
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014357207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030338OtherPHYSICIANS HEALTH PLAN IB
7193668OtherAETNA
247282202OtherUNITED HEALTH CARE
MI4660402-11Medicaid
MI553910515OtherBCBSM
2282530OtherFIRST HEALTH
34418OtherHEALTH PLAN OF MICHIGAN
P00209743OtherRAILROAD MEDICARE
MI4660396-11Medicaid
MI4630299-11Medicaid
MI553910515OtherBCBSM
7193668OtherAETNA