Basic Information
| Provider Information | |||||||||
| NPI: | 1790005627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIVINS | ||||||||
| FirstName: | DUSTIN | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N PARK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693737488 | ||||||||
| FaxNumber: | 2693737478 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 N PARK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693737488 | ||||||||
| FaxNumber: | 2693737478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 5101018758 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RH0003X | 5101018758 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.