Lisa Van Dorp, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5601007489 Issued in MI

Practice address

4000 Wellness Dr
Midland, MI 48670-2000

Phone

(989) 839-3000

NPI assigned

Oct 12, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572998400000",
    "number": "1407227820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5802 S HERITAGE CT",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486403128",
            "telephone_number": "586-917-8237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000",
            "telephone_number": "989-839-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DORP",
        "first_name": "LISA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-12",
        "last_updated": "2019-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601007489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Marie Valley
• Dolores Valtierra, OTRL
• Kathleen Louise Van Belkum, MD
• Nicole Alexandra Van de Velde, M.D.
• Olivia Van Der Leij, LLPC
• Michelle Van Elsacker, DNP FNP-BC
• Kelli Van Wert
• Madison Renee Vanarsdale
• Ashley Vandemark, LLMSW
• Dennis Robert Vandorp Jr., M.D.

• Surgical Physician Assistant in Midland, MI
• Providers in Midland, MI by specialty
• Surgical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.